1999-643 CERTIFICATE ' OF COMPLIANCE
:TOWN OF QUEENSBURY
WARREN COUAITY, NEW YORK
•
Date October 13 19 99
99643
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
25 STEVENSON RD. --._.
Location V
CLEVELAND, KET LY- '& GINUE
Owner
TAX- MAP 'NO. , 26 . 7.4-1 . 2 • By, Order. of Town Board
TOWN°OF 'QUEENSBURY•
Director of Building & Code Enforcement
•
�_ .�
BU-IL.DING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 0 Building Permit No. 99643
TAX MAP NO. 26 . -4-1 . 2
Permission is hereby granted to CLEVELAND, KELLY & GINGER
Owner of property located at 25 STEVENSON RD.
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 NYS Uniform Building Codes and the Queensbury Zoning Ordinance.
•
Owner's Address:
25 STEVENSON RD.
QUEENSBURY, NY 12804
Contractor or Builder's Name:
SANITARY SEWER
Contractor or Builder's Address:
DAN DRELLOS PO BOX 224
GLENS FALLS NY 12801
- Electrical Inspection Agency:
•
Type of Construction:
SEPTIC .
Plans and Specifications:
SEPTIC ALTERATON AS PER PLOT PLAN SPECIFICATIONS
Proposed Use:
SEPTIC ALTERATION
25 October 13. 2001
$ PERMIT 1±,E PAID—THIS PERMIT EXPIRES
(If a longer period is required,an application for an extension must be made to the Code Enforcement
Officer of the Town of Queensbury before the expiration date.)
13 October 1999
Dated at the Town ofQueensbury this } Day of
SIGNED BY �1 . Q� for the Towii of Queensbury
• Code Enforcement Officer
Application for SEPTIC DISPOSAL PERMIT
j ;Town of Queensbuty- �.,�
• ' Dept of Community Development • -` EI�r� Permit No. .�%7 �
• !Building lc Codes Office"
,742 Bay;Road ACT 1 2 1999 Fee Paid($
Queedsbuty,:NY 12804.' TOW,OF
BUfLDIfUO,qEl�SBURY
Location of property for installation: 10 et/,I D_t
Property Owner's Name: XE'U7 61.v9 GLete-e/CAAA)
Property Own 's Mailing Address: r/ ®Wg-
Installer's Name: /tl i 71 (.;!d Phone # 7 92 -7 2-S7
•
Number of bedrooms (if residential): 3 Total daily flow: 9.5-
(residentil -compute @ 150 gal./bdrm.)
Topography: flat, roiling, steep slope % of slope •
' I
•
•
' Soil Nature: sand, L loam, clay, other /depth:
•
•
. Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: not required, required [rate`s 4 min. per inch]
Domestic water supply: municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is .c,)O feet.
PROPOSED SYSTEM
Septic tank)l'0'3 gallon.(rni Ilm.size: 1,000 gal.) (v./Fte„. o
Tile field::'each trench f feet / Total system length: 2 ' feet
•
Seepage pit(s): number of PA- I size each: ft. by ft. •
Size of stone to be used: # /�- / depth or tfirir1cnPc5 feet
•
HOLDING TANK SYSTEM:. (if required)
Number of tanks: Size of each: gallons
&ban s ietem and associated electrical work to be inspected by a certified agency. •
•211-011c,iorlkiafikrotection. please rota that pursuant to°Section 136-29 of the Code of the Town of Qaeeaabary, any porn*or
rI x granted which is based:fin or is granted in reliance upon any material misrepresentation or fsu'tu:e to make a
material fad`or circumstance lmown by or on behalf of as applicant;shall be void.
•
I have read tlie`regulations.with rea applicatma and to abide by these and all requirements of the Town of
'
Queensbsrry'Sazitary Sewage D•
Signature of responsible person: Date: 1246.1___
TOWN OF QUEENSBUR
A BUILDING & CODE ENFORCEMENT
742 Bay Road
a Queensbury MY 12804
74.77
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name6L-6,,X
Location eielf-- 1-,-)<
Date // 1 Permit # ` (- (T"5
SOIL TY'E: . -. oam- .y-
Results of Percolatip st-
(if applicable) Rate Minu a/Inch
TYPE OF SYSTEM:
ABSORPTION F LD: To al Le gth ,?','-)_
Length of each enc ,�, _�,
Depth of trenches -7
Size of stone
SEEPAGE PITS: Numbe -
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tani ' t _
Tank to '-' :: A p6y
D' . x o 'jt Al
Openings Sealed. r ' 31 No Partial
LOCATION/SEPARATIO`• .
Foundation to Tank ya feet
�
Foundation to Absorption 1( feet
Separation of Pits ! �eet
Conforms as per Plot Plan a No
LOCATION OF SYSTEM ON PROPER :
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
L-L D AV,&0•0?-tiot
r1Ct-P Lam° J-
•\ AL.._. _i. \c_ C
SYSTEM USE APPROVED: ES NO
Arrived: si
Depar . 7:
.4416 _
:wilding Inspector
09/30/1999 . 07:26 5187925838 NORTHWINDS MOBILE PK PAGE 01
J-.Y-1 y`�9 2:01 PM FROM STEvES/NACE/MILLER 518 792 8511 P 2,
VAN DUSLN. & STEVES i' ':F''
•
,ICENSEV LAND SURVEYORS
37 CHESTER STREET
GLENS FALLS , ' NE YCRY. 12801
(”8) 79.2-847A
` z
Owners Name: ?�li�a.
L0coLion 4'4,l.,..; ,i
•
PERCOLATION TEST HOLES: • DEEP TEST HOLES
TOTAL DEPTH OF HOLE f.fr " TOTAL DEPTH OF HOLE "
SOIL DESCRIPTION SOIL DESCRIPTION
:z' - ::
644 ..A-t aA .0.�-F _ _ _ -Irs p. .-....11
11... " . . Ir , 11
-IT
PERCOLATION RATE 1" min - MOTTLING " GROUNDWATER "
TOTAL DEPTH OF HOLE " TOTAL DEPTH or HOLE "
SOIL DESCRIPTION SOIL DESCRIPTION
11_ u
-- i
•
-
PERCOLATION RATE 1 - niin MOTTLING " GROUNDWATER
TOTAL. DEPTH -0F HOLE " - TOTAL DEPTH OF HOLE
SOIL DESCRIPTION SOIL DESCRIPTION
11 I, If Ti
11
fl 11' II_ 11 -
-- - 11- I.
PERCOLATION RATE .1" min MOTTLING " GROUNDWATER "
{
DATE: . .q. — 99 TESTS MADE I;Y: �r ,l ��� ���
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,I
Main Office 176 Doe Run Road-Manheim,PA 17545 YN4
MUNICIPAL CERTIFICATE - ELECTRICAL APPROV
Panel Board No Cert. N2 64880 Cut-in Card No
Owner 4 C'eZ
Location 57-6 e $a'Li '' else-t Gf
Installation Consisting of 5 eV)EX f .i 444
•
Installed By 11/ZL C L"Z-t'e-/ Lic.No.
The conditions_following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of making ' spections at any time, and if its
rules are violated,the Companyshall have the right to rev e thi•,f`Icate.
Date /0/Z''7 I INSPECTOR.... Or "`" "--.
TOWN OF QUEENSBURY ni-`
BUILDING & CODE ENFORCEMENTAA- ; U.
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name c' ���Et �}�
Location _ 1j� ,F.1, -.'� �
Date 9 —1L—C1 Permit # DI -C(—)
SOIL TYPE: Sand-Loam-Clay- CA—V1 CI 3
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrived: in:c
Depart:. s ; ,
___41 ..iii,..e,,411-e.......die -..af
:ui 'mg I recto
�� 8 /
Lu
4 ®Q
"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
shown on this document. I also represent that I have
person I y easured the distances set forth on the diagram." II
r
...e %l1 /e7, 1
I
SIGNATURE DATE
d
Lam
'1'..--
1 lc .--,,-- —.z
1-01 ®. s
( 'A-
—mg
o 0 4 1..;
al
1
Fill ft o 1 ' "'A 70 _9 tTh\
LI
1
TOWN F LUJyt-`'''�''(�
•L.lyey ,_- O:►� Y
BUILDING 8g . , ..,„;..,401:Toki. :0-, -, -.
REVIEWED BY
DATE fl417
ir ,
G ow,d,c,