97-238 •
CERTIFICATE' OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date May 22 19 97
3C1 ) 97238
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 •
39 COTTAGE HILL RD . . ` -
Location
Owner. .
MC COURTY:. LAWRENCE KIM --
• TAX 14AP NO. 91 . -5-6 By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY Na 97238
TAX MAP NO. 91 . —5-6 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to MC GOURTY, LAWRENCE & KIM
OWNER of property located at 39 COTTAGE HILL RD, Street, Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC ALTERATTON
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. OWNER'S Address is
39 COTTAGE HILL RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
QUEENSBURY SEWER
3. CONTRACTOR or BUILDERS Address
JAY SWEET
0
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( ) Masonry ( )Steel ( 1
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES May 15 19 99
(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.)
y
Dated at the Town of Queensbury this 15 Day of Ma 97
19
SIGNED BY
for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No. 3E
Dept. of Community Development
Building &Codes Office i • .n
742 Bay Road Fee Paid $�..0
Queensbury, NY 12804
� J
Location of property for installation: O ±f cc -14'(
a
Property Owner's Name: )--f /V y e.
Property Owner's Mailing Address: 3 9 v \ cC ) ,
Installer's Name: C2Gi N Phone # L g- 02- C y e
Number of bedrooms (if residential): 7 Total daily flow: 3
(residential - compute @ 150 gal./bdrm.)
Topography: '- flat, rolling, steep slope % of slope REerzlvED
Soil Nature: )( sand, loam, clay, other /depth: MAY 15 1997
Ground water: at what depth? feet / Bedrock or Impervious Material: 404/idldep'thfPut=a''i eV_RY
BUILDING AND CODE
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.
PROPOSED SYSTEM •
Septic tank: gallon (minimum size: 1,000 gal.)
Tile field: each trench feet / Total system length: feet
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
J
Alarm system and associated electrical work to be inspected by a certified agency.J
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 • •
Date: 7-
Signature of responsible person: /3
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804 •
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date a q7 Permit 17(9.;32°
SOIL T E: Sand-Loam-Clay-
Results of Percola ion T t-
(if applicable) Ra a-M• u e/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD• 1 ength
Length of eac ren
Depth of t nches
Size of tone
SEEPAGE PITS: Num er-
Size - ft. x ft.
Stone size
PIPING: Side Type
Bldg. to Tank ! `jLIJ 17/0
Tank to Dist. Box
Dist. Box to Field/Pi
Openings Sealed? 41110 No Partial
LOCATION/SEPARATION`
Foundation to Tank f O feet
Foundation to Absorption feet
Separation of Pits ____efeet
Conforms as per Plot Plan es No
LOCATION OF SYSTEM ON PROPERT
(circler!)
Front - Left Side - Right Side
Middle t - Middle Rear
CO PENIS:
r,0k Q<- P141 M, C)4iLcil
•
SYSTEM USE APPROVED: 1 /
NO
.rV
Arrived:
Departed: .
Building Inspector
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