1999-751 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date' December 9 19 99
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99751
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
Location
2 6 8 LOCKHART RD. --
Owner GRANGER, MARIANNE
TAX MAP NO. 23 . -1-37 By Order of Town Board
i
N OF U NSB( Li)
UR]�
Director of Building & Enforcement
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 0 Building Permit No. 9,751
TAX MAP NO. 23 . -1-37
Permission is hereby granted to GBANGFB , MAR TANNE
Owner of property located at 268 LOCKHART RD
in the Town of Queensbury,to construct or place a S l P T I.0 AL T sRAT I OI
at the above location in accordance to application together withplot pans an outer information hereto filed and
approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance.
Owner's Address:
268 LOCKHART RD.
LAKE GEORGE, NY 12845
Contractor or Builder's Name:
QUEFNSBURY 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
•
$ 25 PERMIT FEE PAID-THIS PERMIT EXPIRES December 9 2001 .
(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 Town of Queensbury this 9 Day of December 1999
SIGNED BY for the Town of Queensbury
Enforcement Officer
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation: Z.G 1--.0041Ai RT NlTil� R )
File Permit No. 99—W/
Tax Map No. Z . / /(3
•
Owner's Name: M�� k0)JE. GRfltaG�.� Fee Paid m CZ:),
Address: <.6 A E,
2. INSTALLER'S NAME : GA)E E ? Bq PHONE NO.79Z-3 -
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
6980 or oldeD (� x 150 gal/bdrm = ' tD oo
• 1980—1991 x .130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes / no
Spa or Whirlpool Installed yes / no
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
Topography Soil Nature Ground Water. Bedrock or Impervious Material Domestic Water Supply
Fla (sand") at what depth at what depth . municipal
Rolling loam feet feet well
Steep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
• Rate: minute per inch
5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed
professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: \250 gallon (min. size 1,000 gal)
Tile Field: each trench SC) ft. Total System Length: Z t,4j , t
Seepage Pit(s): number of size of each: —ft. by —ft.
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: if required)
Number of tanks: / Size of each: /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
For your protection,please note that pursuant to Section 136-29 of the Code of the Town
of Queensbury, any permit or approval granted which is based upon or is granted in
reliance upon any material misrepresentation or failure to make a material fact or
circumstance known by or on behalf of an applicant, 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.
aLes
Signatu o responsible person 7
J
XL
TOWN OF QUEENSBURY
BUILDING& CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location a`QQ ck l(1)05\e 1 1 . A
Date / ` 1 ' Permit #$ 7S?
SOIL TYPE. Sand-Loam- lay-
Results o ercolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total LengtV
Length of each trench ( 3)
Depth of trenches A
Size of stone Mak
SEEPAGE PITS: um' er-
Size - ft x 1 ft.
Stone size I
PIPING: -- Sjize Type
Bldg. to Tank n Oie-
Tank to Dist. Box a a
Dist. Box to Feld/Pit t., i1
Openings Seale ? Ye No . Partial
LOCATION/SEPA' TI ON9S.
Foundation to Tank / feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as 6 er Plot Plan MD No
LOCATION OF YSTEM ON PROPERT
(circle one
Front - Rea - eft Si - Right Side
Middle Fro t - Mi e Rear
COMMENTS: , n
•
SYSTEM USE APPROVED: YES NO
Arrived: •
5�
Departed: Pik
Building Ins eFtor
,,.
r!'
9n: ---. 7S
TD �,,, 1999 a
__ _____,_, % 7\ ,
, I ir X
TOWN OF UE a fS4.jRY
P / /
REVIEWED BY . 1:4' . .,_ , if 1
DATE l '``l
f
P
17
"1 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
pe sonally measur i the distances set forth on the diagram."9.9 7 51
>ri-
- /:- -.-E— 9f
GRANGER,, MARIANNE, SIGNATURE :.DATE
26.8 LOCKHART RD.
SBPTIC ALTERATION `` :
;
r. 23