1999-442 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSOURY
WARREN COUNTY, NEW YORK
Date July 19 19 99
;\" ' "
99442
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 .
107 WEST MT. RD.
Location
Owner NTCHOLS, EDGAR & JANE
TAX MAP NO. 124 . -2-9 By Order of Town Board
, TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE. $ 0......: TOWN OF QUEENSBURY No. 99442
TAX MAP NO. 124 . —2-9 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to NICHOLS,: EDGAR & JANE
OWNER of property located at 107 WEST MT. RD. 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. OWNERS Address is
. 107 WEST MT. RD.
QUEENSBURY, NY. . 12.804 . .
2. CONTRACTOR or BUILDERS Name
QUEENSBURY SEWER
3. CONTRACTOR or BUILDERS Address .
JAY. SWEET .
4. ARCHITECTS Name
•
5. ARCHITECTS Address .
6. TYPE of Construction—(Please indicate by X)
SEPTIC•-
( 1 Wood Frame ( I Masonry ( )Steel ( )
7. PLANS and Specifications
SEPTICNd,1LTERATION AS .PER PLOT PLAN SPECIFICATIONS:
8. Proposed Use
SEPTIC ALTERATION
July.,:19:r ;.. ..
$ PERMIT FEE PAID -THIS PERMIT EXPIRES - f001
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of-the
town of Queensbury before the expiration date.) . .
19...
Dated at the Town of Queensbury this Day of
SIGNED BY a for the Town of Queensbury
Building and Zoning Inspector
Application.for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept_ of Community Development -Permit No. ("I I ^"(4K
Building &Codes Office
742 Bay Road Fee Paid
SX.5_,_
Quensbury, NY 12804 C
l.
RF
Location of property for installation: /j} 7 it)&sue X,(*
...___JUL N 1 9 1e99CSi3URsr
Property Owner's Name: Ed 0 I 1 �L b Is -
TOWN Gt t`a`
NE
17
Property Owner's Mailing Address: C? h. -Q, ___ 00E
.
Installer's Name: 0 c.t e W r c(_Y- 1 � -e.�vac
Phone # 19 2 ‘ ve
. c. Number of bedrooms (if residential): Total daily flow:
(residential -compute @ I50 gal./bdrm.)
Topography: y flat, rolling, steep slope % of slope
Soil Nature: X sand, loam, clay, other /depth:
• Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: ) not required, required [its min. per inch]
Domestic water supply: )C municipal, well, other
If domestic water supply is a WFT.T, water supply from any septic absorption is feet.
PROPOSED SYSTEM
•
Septic tank%-) gallon (minimum size: 1,000 g..1.)
Tile field: each trench feet / Tot l system Iength: feet
Seepage pit(s):•number of / size each: . ft.by ft.
Size of stone to be used: # I depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: : Size of each.: gallons
&hum system and associated electrical work to be inspected by a certified agency.)
For y oi.:protection, please note that pursuant to Section 136-29 of the Code of the Town of Qneensbury, any permit or
approval granted which is based upon or is granted is reliance upon a y mPrprial misrepresentation or failure to make a
material fact or circumstance known by or on behalf of an applicant, c �+II be void.
I have read the regulations with respect to this application and as to abide by tbeee and all requirements of the Town of
Queensbmy Sanitary Sewage Disposal • .[.`,
Sin atz:re of responsible person: i l L ,..,____/--,
Date: 7-- f‘: r
i
TOW?!itik QUEENSBURY
BUILDING A CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 44Ctf-eof
Location / '7 ki, ati` 1e 2
Date 7/// 9 Permit # qy 1/zi
l
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate- • • e/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: T'ital Le gth/.-
Length of, each tre ch 1
Depth of 'trenches
Size of stone
SEEPAGE PIT . Nu ber-
Size - ft.
Stone size
PIPING: Size Type .—
Bldg. to Tank 2q Gib1,)
Tank to Dist. Box �=--
Dist. Box to Fi ld/P 't
Openings Seale ? Yes No Partial
LOCATION/SEPA TIONS. �1
Foundation totank [ V. feet
Foundation to bsorption ;--- feet
Separation of Pits f-'feet
_
Conforms as per Plot Plan des , No
LOCATION SYSTEM ON PROP'R. ?�
(circle oni�
Front - ear Left Side - 'ig t Side
Middle Fro - Middle Rear
COMMENTS:
1—Pc miN Rc_.-ipz...4 ./Tv\ iti\
0NCI
if
SYSTEM USE APPROVED: YES NO
Arrived:
Departed: - c7
Building Inspector
Jul_) ....> ' Acl—z-ii-ic),
. qz. c._, 03 .
- (1--(‘ 1::? ri..--
1 9 1999
Tovviv.
BuRy
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TOWNE' 7-tr. QUEEN B 1(
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DAT'E -Z ,/7. 12...._,....
IA 0
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0 t i r "I have see'i or observed, or believe 1 saw evidence of,
='_. P y.. • K all GbiF:r.?:c such as houses, wells,trees,fences,etc.,
;a:' shown Diu this Jocument. I also represent that I have •
'` ;
` perso ' . measured the d. tances se forth on the diagram."
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1-- al 18 . - GNATURE DATE
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