1999-727 CERTIFICATE OF COMPLIANCL , , •
TOWN OF UUEENSB.URY
WARREN COUNTY,., NEW YORK"
December: 2 = 99
Date 19 -
•I ' I • . 997 '2
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' ' a f .
10- PINEWOOD HOLLG .RD.
. - . Location . :
.
. •U ERM Y-1;K, Jr�I S. & a�ELLY .Owner
TAX MAP'_NO, 90. -5.-11 By Order of Town ,Board ,
•
'TOWN',OF QUEENSBURY:
•
Director of Building Code Enforcement
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 0 Building Permit No. 9 9 7 2 7
TAX MAP NO. 90 . -5-11
Permission is hereby granted to OBERMAYER, JAMES & KELLY
Owner of property located at 10 PINEWOOD HOLLOW 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:
11 PINEWOOD HOLLOW RD.
QUEENSBURY, NY 12804
Contractor or Builder's Name:
• - QUEENSBURY SEWER
Contractor or Builder's Address:
JAY SWEET
0
Electrical Inspection Agency:
Type of Construction:
SEPTIC _
Plans and Specifications:
SEPTIC ALTERATION AS PER PLOT.. PLAN SPECIFICATIONS
Proposed Use:
SEPTIC ALTERATION
•
$ 2 5 PERMIT FEE PAID-THIS PERMIT EXPIRES November 29 2 001
(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.)
Dated at the To Qu ury this 2 9 Da November 19 9 9
SIGNED for the Town of Queensbury
o E rce t Officer
Application for SEPTIC DISPOSAL PERMIT
•
Town of Queensbury
Dept. of Community Development Permit No. i — 7
Building &Codes Office
742 Bay Road RECEIVED
dp
Queensbury, NY 12804 �` �`�® Fee Paid $ ,
NOV 2 4 1999
Location of property for installationTO`y°�l %F Q � i'J 2J ,, d d 14 J
JILDING AND CODE
Property Owner's Name: - --/ AN 0 -e r r l o r .
Property Owner's Mailing Address: I() p( KtiU o o 4 no-. 1
•
Installer's Name: Q e i,}`S But 7 at., e(`'Phone # 7 —23 C ci OV
Number of bedrooms (if residential): 3 Total daily flow: 1-7.5-7)
(residential -compute @ 150 gal./bdrm.)
Topography: A/ flat, rolling, steep slope 7 of slope
Soil Nature: ic sand, loam, clay, other /depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: X not required, required [rate min. per inch]
Domestic water supply: X municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSEDEm
•
Septic tank(dire gallon (minimum size: 1,000 al.)
Tile field: each trench ,4-7) feet / Total system length: o2-(-3-7) feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: #�� 2- / depth or thickness " 1 feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: : Size of each: gallons
(Alarm system a:nd associated electrical worse to be inspected by a certified agency./I
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any pe-.nit or
ap iruval granted which is based upon or is granted in reliance upon any material misrepreseutation or failure to make a
material fact or circimistance known by or on behalf of an applicaot, shall be void.
I have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: 1 rDate: /ram 11,2- 97
TOWNrOF 9UEENSBURY
BUILDING& CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518)761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name OW WI-'0.
Location giAeTo/A0 &et-A)
Date - 1 Y Permit #
SOIL TYPE: Sand Loam-Cla
Results of '-rcolation Test- 1
(if applicable) Rate-Mintte/Inch
TYPE OF SYSTEM: I l
ABSORPTION FIELD: Total L �th
Length of each�� rench l ..�
Depth of trenches
Size of stone )j
SEEPAGE PITS: Number- I
Size - ft. x / ft.
Stone size
PIPING: ize ,Type
Bldg. to Tank /5/ 420l25
Tank to Dist. Box
Dist. Box to Field/ ' ��� `f
Openings Sealed? Yes No Partial
LOCATION/SEPARATION •
Foundation to Tank. feet
Foundation to Absorption -5Z feet
Separation of Pits
Conforms as per Plot Plan es No
LOCATION OF SYSTEM ON PROPER •
(circic,
Front Rear - Left Side - Right Side
Middle • t - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrived:
Departed:
Building Inspector
a7
. _1 4V ED
NOV 2 4 1999
TOWN OF QUEEs4 sBURY
BUILDING AND CODE
n
iSl
L=5",
1., TR) rt u-)1 d -0(
"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 `'J
pers a measured the d'. nos') forth on the diagram."
ATURE DATE
TOWN OF Q EEN BU Y
TOWN OF QUEENSBURY BUILDING DEPARTMENT
Based on our finked examination, BUILDING & S PT.
compliance with our comments shall
not be construed as indicatingthe REVIEWED BY
plans and specifications are m full
compliance with the code. DATE a