97-516 •
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
•
WARREN COUNTY, NEW YORK
Date r, _,f.e,�� .� - ,n, 19 'CV-7
i- (
16
This i s to certify that work requested to be done as shown by Permit No. '75 ___
has been completed.
• Thi s structure may be used as a SEPTIC ALTERATION
Location 89 HIYJILlAND RD.
Owner L:I NTON, KE NNETH &
By Order of Town Board
TAX MAP dO. 6g. —1 -3 TOWN OF QU URY
Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ ' 0 No. 9751G
TAX MAP NO. 60. -1-3 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to T.INTON, KENN-ETH &
OWNER of property located at P 9 HAVILAND RD. Street, Road or Ave.
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 Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
MARGARET 89 HAVILAND RD
QUEENSBURY NY 12804
2. CONTRACTOR or BUILDER'S Name
SANITARY SEWER
3. CONTRACTOR or BUILDERS Address
DAN DRELLOS PO BOX 224 -
GLENS FALLS NY 12801
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEf IC
( )Wood Frame ( 1 Masonry ( )Steel
7. PLANS and Specifications
SEPT1°' ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES September 8 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 Oueensbury before the expiration date.)
Dated at the Town of Queensbury this 8 Day of September 19 97
SIGNED BY for the Town of Queensbury
��-� \
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No. 9 7'✓l
• Dept. of Community Development
Building&Codes Office p()
742 Bay Road Fee Paid $ Sv
Queensbury, NY 12804
Location of property for installation: q Au/ L/ .0)
/20
Property Owner's Name: /?t? L/ i
RECIFIvED
Property.Own 's Mailing Address: /7/4-1J‘(--I O
0 41997
Installer's Name: 1 AN fi;f1/ d. c Phone # 7 a EuRY
BUILDING AND CODE
Number of bedrooms (if residential): Total daily flow: 6.
(residential -compute 10 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
• Soil Nature: CL sand, x loam, clay, other /depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: required, required [rate min. per inch]
Domestic water supply: iicipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
•
PROPOSED SYSTEM
Septic tank )c s °gallon (minimum.size: 1,000 gal.).,
Tile field: each trench feet / Total system length: P-c-CJ ' feet
•
Seepage pit(s): number of / size each: ft.by ft.
•
Size of stone to be used: # / depth or thickness l feet
•
HOLDING TANK SYSTEM:. (if required)
Number of tanks: Size of each: gallons
&hum system sad associated electrical vwncc to be inspected by a certified agency. ) .
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queeasbmy, any permit or
approval granted which is based upon or is granted in reliance upon any material misrepresentation or faun to make a
material fact or circumstance]mown by or on behalf of an applicant;shall be void.
I have read the regulations with s ' application and to abide by these and all requirements of the Town of
Queenshury Sanitary Sewage Disposal / o
Signature of responsible person: Date: 2 7 / 2
TOWN OF QUEENSBURY
BUILDING RI CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPCTION
Na e
Location _ ilsr la la
Date Permit 97
5 16)
SOIL T 'E: Sand-Loam-Cla -
Results of Percolation est-
(if appli able) Rate-M'nute/Inch
TYPE OF S TEM:
ABSORPTION IELD: Total Length
Length of e.ch trench
Depth of tre,ches
Size of stone
SEEPAGE PITS: Numb:r-
Size - , t. ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Bo
Dist. Box to Fie d/'it
Openings Sealed? es No Partial
LOCATION/SEPARAjIONS:
Foundation to lank feet
Foundation to bsorptio feet
Separation of Pits _ feet
Conforms as ser Plot Plan Yes No
LOCATIr: OF •YSTEM ON PRO' RTY:
(circle one)
Front - Rea( - Left Side - 'ight Side
Middle Fron - Middle Rear
COMMENTS:
Vi'OLLF
SYS M USE APPROVED: wai_ NO ik
Arrived: ,add' •
Departed /
tiding Ins a or
•
TOWN OF QUEENSBURY .
BUILDING E CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPT" DISPOSAL SYSTEM INSPECTION
Name LI 01—n0Y1
Location _ e. ' _`t�YI 1
Date O 1' 01 Permi # . 5143
. goi\l
SOIL TYPE; Sa :-, Loam-Clay-
Results of Percolation Test
(if applica,le) Rate-Minut:/Inch
TYPE OF SYS EM:
ABSORPTION "IELD: Total •ngth 7, t
Dio
Length of ea, h trench ' CO Ste'
Depth of tre ches 7 a
Size of stone • z
SEEPAGE PITS: Number
Size - ft. x ft.
Stone size
PIPING: yp
e
Bldg. to Tank S�.1ert,ljC, -V�
Tank to Dist. Bo . ii i(
Dist. Box to Fiels/'it 1-trc '9\.)(1 �
Openings Sealed? y _` No Partial
LOCATION/SEPARATI, 5:
Foundation to Tan _,_34- feet
Foundation to Ab orition feet
Separation of P 'ts _ -®- feet
Conforms as per Plot Ian Yes)No
LOCATION OF SY M ON "ROPERTY:
(circle one)
Front - Rear -ft Side- - Right Side
Middle Front Middle Rea
COMMENTS:
/. ' - _----S;) . 'V-10 tt
1
II
SYSTEM(USE APPROVED: L-.
NO
D:lart- i : 11
Building, spect,r
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT C��
742 Bay Road
Queensbury NY 12804 Ai
(518) 761-8256
SEPTIC 'ISPOSAL SYSTEM I SPECTION
G-0149
Name 16E10 LA 11
Location*a\ \- PA)1_a Vj C\p
Date c1M 7 Permit • t7
SOIL TYPE: Sa d-Loam-Cla -
Results of Per olation Trst-
(if applicable) Rate-Min to/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD Total Length
Length of each t -nch
Depth of trenches
Size of stone
SEEPAGE PITS: Numier-
Size - ft. , ft.
Stone size _
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pig
Openings Sealed? Ye• No Partial
LOCATION/SEPARATIONS
Foundation to Tank feet
Foundation to Absorp ion _ feet
Separation of Pits feet
Conforms as per Plo Plan Yes No
LOCATION OF SYSTEM 0 PRO' RTY:
(circle one)
Front - Rear - Left Side - 'ight Side
Middle Front - Middle Rear
COMMENTS:
F . C Ea.
SYSTEM USE APPROVED: S NI
Arrived-
Depar 1 a 1%
AL•:c
g nspect
Dare 3C
• &() P
see D
�
30 pod L.
"I have seen or obsetveds erbegotI maidens ofr
all objects such as boss,waist took foseeotC.,
shown on this document.! !hove
personally measured the distances set foam the diagram.'
( ?-/G
SIGniti URE DATE
�t L