98-585 4 L _.
CERTIFICATE O.1+' COMPLIANCE
TOWN OF QUEENS@URY
WARREN COUNTY , NEW YOR'K
Date SeptemDer 22 19 98
r IP* '. 98585
This is to ccee`rtify that work requested to be done as shown by Permit No ,
has been completed .
SEPTIC ALTERATION
This structure may be used as a -- -
Location 96 COUNTRY CLUB RD .
MOTT , LLOYD r JR . &
Owner
TAX MAP NO . 6 7 . - 2 - 11 . 1 By Order of Town Board
TOWN OF QUEENSOURY
00/0
Director of Building & Code Enforcement
11
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY
TAX MAP NO . 67 . — 2 - 11 . 1 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to
Street. Road or Ave.
OWNER of property located at 96 C
in the Town of Queensbury. To Construct or plans a
AMTON 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 Clueensbury Building and Zoning Ordinance.
1. O WN E R"S Address is
VIRGINIA 96 COUNTRY CLUB RD .
QUEENSBURYe NY 12804
2. CONTRACTOR or SUILL1E" Nam
QUEENSBURY SEWER.
M CONTRACTOR or BUILDER'S Addren
JAY SWEET
0
4. ARCHITECT'S Name
5, ARCHITECT'S Address
S. TYPE of Construction — IPk mne indicate by X} SEPTIC
} Wood Frame i I Masonry ( I Steel f I
7. PLANS and Specifications
SEPMXC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$. Proposed Use
SEPTIC: ALTERATION
25 September1175 2000
PERMIT FEE PAID - THIS PERMIT EXPIRES
$
(tf a longer period k required an applicat ion for an extenrian n+ust be made to tote Building and Zon" Inspector of the
town of Ltttiernsbury before ow expiration date.t
17 September 1998
Dated at the Town of Qu,eernsbury this --
pay of 19
for the Town of Gueensbury
SIGNED BY B.rildins and onion terspoom~
Application for SEPTIC DISPOSAL PERMIT
Town of [hceensbury Perrrut No.
Dept. of Community Development
Building & Codes office
742 Bay Road Fee Paid
Queensbury, NY 12804 //
Location of property for installation: =�I. �(e.7 `
Property Owner's Name: - -`i
Property Owner's Mailing Address: .J a Y11 e"
Installer's Name: E' k} yt7 cc {� C Phone # x9k7
��-
Number of bedrooms (if residential): Total daily flow: C3 -z:}
(residential - compute Q 150 gal.lbdrm.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other f depth:
Ground water: at what depth? feet f Bedrock or Impervious Material: at what depth.? . feet
Percolation test: not required, required [ rate min. per inch 1
Domestic water supply: municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tanklO-SZ) gallon (minimum size: 1,000 gal.)
Tile field: each trench edq�{,Z feet t Total system length.: _ feet
Seepage pit(s): number of f size each: ft. by ft.
Size of stone to be used: #" _ f depth or thickness JC� /� feet
HOLDING TANK SYSTEM: (if required) SEp yl , 1998
Number of tanks: Sire of each: ,bons
AIarm system awl associatcxi electrical avrk to be inspected by a certified agency.
For your protection, Please now that Pursuant to Sectiort l3fr-29 of the Code of the Town of Queembury, any permit or
approval granted which is based i*on or is granted im reli nce uPon any material miar"Presentatiou or faflure to make a
material fact or c%rccunstanca known by or on behalf of an applic.zt, shall be void.
l have read the regulations with reaPect to this application and agree to abide by these a:od all requirements of the 'Town of
Queensbnuy Sanitary Sewage D isPosal ordhumce.
Signature of responsible person: Date: � `�'!
TOWN OF QUEENSSURY
BUILDING A CODE ENFORCEMENT
742 Bay [toad
Queensbury NY 3.2804
(SIB) 761-9256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name / y ' 4
Location �-
Date 2_
Permit # J
SOIL TYP San - Loam- Clay-
Results of Percolation Test-
( if applicable ) Rate-Minute/ lnch_�� 1
TYPE OF SYSTEM:
ABS PTION FIELD : Total n9,thl —
Lengt f each trench
Depth of ches
Size of stone —"
SEEPAGE PITS : Nt sber- _ ft .
Size -
Stone size
PIPING: S� ` '*
Bldg . o Tank
Ta to Dist . Sox
. St . Sox to 'Field/Pi "No arti a
Openings Sealed .
e ;
LOCATIONISEPARATI feet
Foundation to Tank eet
Foundation to Absorption feet
Separation of Pits es No
Conforms as per Plot PPROan PER
LOCATION OF SYSTEM ON
( circle one)
Front - Rear - L t Side - Right Side
Middle Front - r
COMMENTS
SYSTEM USE APPROVED
E NO
Arrived:
Departed : Ole
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