1999-568 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date September 3 . ig 99
301 •
99568
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
227 FIFTH ST. EXT.
�� Location
HAVENS, MEARL & DAVI S,
Owner
TAX MAP NO. 131 . -7-9 By Order of Town Board
.. TOWN OF QUEENSBURY
//. . —7
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF . QUEENSBURY No. 99568
TAX MAP NO. 131.. —7-9.
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to
HAVENS, MEARL. & DAVIS,
227 FIFTH ST. EXT. Street,Road or Ave.
OWNER of property located at
in the Town of Oueensbury,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. glIVAIII.,Addnii FIFTH ST EXT.
QUEENSBURY, NY 12804 ..
2. CONTRACTOR or BUILDERS Name
CONDON SEPTIC & DRAIN SERVICE .
3. CONTRACTOR or BUILDERS Address
4. 'ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X) SEPTIC.
( 1 Wood Frame ( )Masonry ( )Steel 1 1
7. PLANS and Specifications
SEPTIC ..ALTERATION.....AS._ PER._PLOT PLAN SPECIFICATIONS
No.
8. Proposed Use .
SEPTIC ALTERATION
Z5.. _:;i.;:. September 1 2001
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town.of Oueensbury before the expiration date.)
1 September 1999
Dated at the Town of Queensbury this Day of 19
SIGNED BY _ for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury9(
Dept_ of Community Development •Permit No. (Q
Building &Codes Office
742 Bay Road Fee Paid $ ' 00
Queensbury, NY 12804
Location of property for installation: a Z7 S
RFCEIVED
Property Owner's Name:go i/ 84v f SEP 0 i 1999
Property Owner's Mailing Address: 2)-7 S7 . ex 7 TOWN OF O'w;y i_:,,1.,JURY
I3UILuml a Am-) COOP
-
Installer's Name jj1/y ,4,D /G 'l-�119/itiffik Phone #
Number of bedrooms (if residential): Total daily flow: l CC
(residential - compute @ 150 gal./bdrm.)
Topography: y flat, rolling, steep slope % of slope
Soil Nature: X sand, loam, clay, other /depth:
Ground water: at what depth?fk feet / Bedrock or Impervious Material: at what depth44 feet
Percolation test: not required, required [rate min. per inch]
Domestic water supply: "X municipal, well, other
If domestic water supply is a WFT.T, water supply from any septic absorption is feet.
PROPOSED SYSTEM
CN1b fe)aCk �,
Septic tank- l� gallon (minimum size: 1,000 scat) p
Tile field: each trench JQ feet / Total system length: IAfeet
Seepage pit(s): number of / 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
Alarm system and associated electrical work to be inspectad by a certified agency.
For y ois protection, please note that pursuant to Section 136-29 of the Code of the Town of Qaeeasbury, any permit or
appwval gmA-4Y? which is based upon or is granted in reliance upon any material misrepresenta6on or failure to make a
material fact or circumstance known by or on bebalf of an applicant, ;hall be void.
I have read the regulations with respect to this application and a�ee to abide by these and all requirements of the Town of
Qi nsbmy Sanitary Sewage Disposal Ordinance.
Signature of responsible person: Xtitf ngZArA. _ Date:
TOWN OF QUEENSBURY r eU
BUILDING & CODE ENFORCEMENT / v `
742 Bay Road 4�\
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 'cf\e/V ) \A(LUP/VV7 )
Location .0 j ' cl:\,---c--4T --y_yeef%(
sX`('o
Date _ _ Permit # - —
SOIL TYPE: Sand oam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Lemjh 1O
Length of each trench i 5'U
Depth of trenches
Size of stone 4Z--Aillik
SEEPAGE PITS: Numbe
Size - ft. . ft.
Stone size
PIPING: 'ize Type
Bldg. to Tank 6----C/67-/.)-6
Tank to Dist. B..
Dist. Box to Field '' t " v
Openings Sealed? es_ No Partial
LOCATI ON/SEPARATI O .
Foundation to Tank ," feet
Foundation to Abso ption _ feet
Separation of Pit eet
-Conforms as per P `ot Plan es No
LOCATION OF SYST ON PROPER :
(circle one)
Front - Rear - f Side - Right Side
Middle Front - Mid
COMMENTS:
•
SYSTEM USE APPROVED: I.
NO
Arrived: r
Departed: ,
_\UeC._
Building Inspector
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IP
RECEIVED
P 0 2 " seen or observes, eve I Fences,etc.,w evidence of,
SE1999 "I have
TOWN OF OUEENSBURY all objects such as houses,wells,
represent that I : agra ."
a c� non forth tth
UILDoNG AND CODE�� c show
measured the distances set •
a,Q . personally m `�,�—
aci
9 �� � 17
DATE
SIGNATURE i
is gX
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SEP o 1 1999 6
Btllt_DiNG ANC:r • l:Y 71
"I have seen or observed,or believe I saw evidence of. 'D
all objects such as houses,wells,trees,fences,etc., R. FILL'
shown on this document I also represent that I have
personallymeasured the distances set forth on the diagram."
Ici> 041:66 . . . ,. ?-- i -Pr
. SIGNATURE DATE
TOWN OF O . E NSBURY
TOWN OF GUEENISBDP'DG.L NG DEPARTMENT ® N i C. X
Based on our limited examination,
compliance with our comments shall REVIEWED E3`�" _
not be construed as indicating the DATE q l
plans and specifications are in full / l
compliance with the code.
,-1-� cTN sr ex7'