1999-427 Certificate of • Compliance
Town of Queensbury
Warren County,New York
July 1 99
Date • ,••
\ 13- 994127
This is to certify that work requested to be done as shown by Permit No.• •
has been completed.
SEPTIC ALTERATION
This structure may be used as a •
2 TREEHOUSE LANE •
Location
Owner COZ ZENS jOHN, JR. &
TAX MAP NO. 90. -6-10
By Order Town Board
TOWN OF QUEENSB7Y
•
Director of Building Code Enfordement
•._ •
BUILDING PERMIT
" TOWN .' OF.. QUEENSBURY No...• 99427
TAX MAP NO. 90. —6-10 WARREN COUNTY,NEW YORK.
PERMISSION is hereby granted to' COZZENS, JOHN, JR-. &
OWNER of property located at• 2 TREEHOUSE LANE Street.Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC ALTERATION
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
MARYANN 2 TREEHOUSE LANE
QUEENSBURY,: NY 12804
2. CONTRACTOR or BUILDER'S Name
SANITARY SEWER
3. CONTRACTOR or BUILDERS Address
DAN•.DRELLOS. PO BOX 224
GLENS FALLS. NY .12801
4. ARCHITECTS Name
5. ARCHITECTS Address .
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( I Masonry ( )Steel ( )
7. PLANS and Specifications
SEPTIC ALTERATION AS. PER PLOT PLAN.•. SPECIFICATIONS'.
8. Proposed Use -
�EPTIC ALTERATION
25 July;. 12 4)01
$ PERMIT:FEE PAID —THIS PERMIT EXPIRES
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbuty before the expiration date.)
12 .: July. 19 1999 •'
Dated at the Town of Queensbury this Day of
SIGNED BY �� for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No.:
Dept of Community Development
$Wilding afi
&Codes Office
742 Bay Road Fee Paid $ ,
Queensbur�r, NY 12804
Location of property for installation: (L 7/ e o
Property Owner's Name: <5-0 t ec).l'
Property Own Mailing Address: (. :9/ttg
Installer's Name: 4/i /;Ay e/-- Phone # 7 91 -•
Number of-bedrooms (if residential): _7 Total daily flow: %5D
(residential -compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
• Soil Nature: 4_sand, loam, clay, other /depth:
• • Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: aL not required, required [rate min. per inch]
Domestic water supply: municipal, well, other
•
If domestic water supply is a WELL, water supply from any septic absorption is feet.
•
PROPOSED SYSTEM
• 0a•3 EX/rTi• ° E►
Septic tanlc gallon (minimum.size: 1,000 gal.)
Tie field:;'each trench 1 - feet I Total system lenth: " ' feet
•
Seepage pit(s): number of I size each: ft. by ft. •
Size of stone to be used: # / depth or thickness . / feet •
•
HOLDING TANK SYSTEM:. (if required)
Number of tanks: Size of each: gallons
&lama system and associated electrical work to be inspected by a ceatrfed agency. •
ti
�Y rNForyour ptotec ion. please note that pursuant to Section 136-29 of the Code of the Town of Qaeenabwy, any permit or
.apP?RvAl,granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a
::r mate;a fict,or circumstance known by or oa behalf of an applicant;shall be void.
I have read the mgukatiams with respect �' . and agree to abide by these and all requirements o the Town of
Qn a,alnny'Sanitary Sewage Disposal u�PT!�,
Signature of responsible person: III / ._; �/ 1 Date: / 9
c '' )V
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY I2804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name Z \
Location �( P.
Date 1-1(-1-ri Permit #9Cr`-1 7
SOIL TYP : Sand�Loa -Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total *gth 7j
Length of each trench
Depth of trenches i
Size of stone . 7,
SEEPAGE PITS: Number-
Size - _ ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank E'_y.`j`t _
Tank to Dist. Box yas •
Dist. Box to Field/Pit LI%
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank ri_j 1; feet
Foundation to Absorption _Zp feet
Separation of Pits feet
Conforms as per Plot P1 an 44111t1
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left - ight Side
Middle Front middle Rear
COMMENTS:
•
SYSTEM USE APPROVED: 4111111111110
Ni,
Arrived* ,b
Addilligr
Depar•ed: 6%
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Pr Building In tor
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"I have seen or observed,or believe I saw evidence of,
all objects such as houses,wells,trees,fences, etc., Lf
ppeoitts)) this documen I also r esent that I have
cson y measure t 'sta set forth on t diagram."
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RECEIVED
iiim \iet °1s?De JUL 1 2 1999
TOWN OF QUEENSBURY
I/ BUILDING AND CODE
1,, •
e/.,
\ raee kv", 4016
V.•: ':-z: ,
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/� (.. .-&_it 0 C-' g-
"I have seen or observed,or believe I saw evidence of,
all objects such as houses,wells,trees,fences,etc.,
Oawk on this documen I also r Resent that I have
'pepoiii,y measure t 'sta "set forth on diagram."
77 / S
SIG T E` DAT
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BUIL. : , ' 4JyP ..PT.
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®ATE . , �:t '7K .. ____
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I RECEIVED
SrD JUL 12 1999
TOWN OF QUEEN BURY
I , BUILDING AND CODE
ys
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