98-735 CEI- TIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY . NEW YORK
Date November 30 19 98
98735
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 --
34 FOREST LANE
Location —
LAW : LINDA CHILSON
Owner I —= -�
TAX MAP NO . 122 . - 1 - 2 . 5 / SG�r E3varci
/ G N O !TEEN SANY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY
TAX', MAP NO . 122 . - 1 - 2 . 5WARREN COUNTY, NEW YORK
pen MISSION is hereby granted to
Street. Road or Ave.
OWNER of property located at %my
In the Town of Oueensbury. To Construct or place a
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 Chasensbury Building and Zoning Ordinance.
t. O WNE R5 Addraw is
1204 KATHAN RI] ,
CORINTI NY 12822
IIIIIIII
2. CONTRACTOR or BUILDER'S Nance
COOKS SEPTIC
3. Cp Y TRACTOA or BUILDERS Addrass
12801
4. ARCHITECTS Name
5. ARCHITECT'S Address
6. TYP£ of Construction - IPlesse indicate by X) SEPTIC
l I Wood Frame l I Masonry I I Steel l I
V. PLANS and SpecRicatiom
SERMIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
a. Proposed Use
SEPTIC ALTERATION
III 2S November 2% 2000
S PERMIT FEE PAI0 — THIS PERMIT EXPIRES
lager parted is •+4''k� an application fw an eattnsion mast be '�t+ to the Buildk* and Zam" inspector of the
(if a
town of C'kmwmjburV before the ewpiration date.!
25 November 19 199 $
Dated at the Town of Oueenawry this Day of
for the Town of Oueensbury
SIGNED BY and ZorA !
Application for SEPTIC DISPQSA.T.� PERMIT
Town of Queensbury
Dept. of Community Development Permit N � ^✓
Building & Codes Office [j V
242 Bay Road Fee Paid S
Queeasbury, NY 12904
i.ocadon of property for installation:
Property (owner's Name: _ z./r
y� OVQy 1998
Property Owner's g Address: fGrr.t �� 6� -e /,1�
Installer's Name: / r .� Phone #` �,�c� e S' 9
Number of bedrooms (if residential.): '` Total daily flow:
(residential - compute 0 150 gal.Ibdrrn.)
Topography: " L/ flat, rolling, steep slave °ra of slope
Soil Nature: sanV d. loam, clay, other I depth:
Ground water: at what depth? feet I Bedrock or Imnervi.ous Material: at what depth? feet
Percolation test: not m uired., required [ rate min.. per inch ]
Domestic water supply: �unicipal, 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 al.) �+�i7 � Yc 4X �
;;z -100 tc�,-Ile
Tile field: each trench c?F 'feet / Total system length: 52jV0 feet
Seepage pit(s): number of / size each: . ft. by fL
Size of stone t4 be used: ` I depth or thickness feet
HOLDING TANK SYSTEM. (if required)
Number of tanks: Size of each: gallons
A3arm system and associated electrical work to be *ate a� by a certified a ~y.
For youx protection, please note that pursuant to Section. 136-29 of the Code of the Town of Qoacmba y, arty' laertMit or
approval granted which is based upon or is granted is reliance ulsaz any material misrepTeserMztioa or farlure to make a
material fact or Q=* , zstance known by or an behalf of &a applicant, shall be void.
I have read the rag t ti w with respect to this application and agree to abide by these sad all rageriremcats of the Town of
Queensbuxy 5a=Aary Sewage Disposal 7
..ti ,.-.
Signature of responsible person: Date:
TOWN OF QUEENSBURY
BUILDING N CODE EKFORCEP"T
742 Bay Road
Queensbury NY 12804
(518) 761-9256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
_ � 66r Lti .
Date + ice Ts
t # 76` `��5
SOIL TYPE: Sand- Loam- clay-
Resul is of Percol ati on Test-
( if applicable ) Rate-Minute/ Inch
TYPE OF SYSTEM=
ABSORPTION FIELD: Total Length
Length of each trench
Depth f trenches
Size o tone
' SEEPAGE S : N um -f t
Size - • x
Stone sire �.. Size ype
PIPING :
B 1 d g . to nk �--- -- ----
Tank to st . Box Dist . B x to Field/pit s��- arti a
(}peni s Sealed ?
LOCAT ON/SEPARATIONS : feet
Foundation to Tank tion ~~~ feet
Foundation to Absorp ----— feet
Separation of Pits -- --ems N0
Conforms as per PlOtan
LOCATION OF SYSTEM ONPPROPERTY •
( circle one) - Right Side
Front - Rear - Left Side 9
Middle Front - Middle Rear
COMMENTS
ctn't
SYSTEM USE APPROVED :
YES NO
Arrived:
u
Departed : •''
Bui ng nspector
di
TOWN OF QUEENSSURY
BUILDING A CODE ENFORCE14ENT
742 Say Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date 14 Permit #
SOIL TYPE : Sand- Loam-Clay-
Results of Percolation Test-
( if applicable ) Rate-Min ch
TYPE OF SYSTEM:
ABSORPTION FIELD : Tot Lengt
Length of each trenc
Depth of trenches
Size of sto e
SEEPAGE PIT N
Size - t . x ft ,
Stone Size
PIPING : Size ype
Bldg , to Tan
Tank. to Dist . Sax
Dist . Box to Field/Pit
openings Sealed ? Yes Na T7artial
LOCATI ON/SEPARATIONtS : feet
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY :
( circle one )
Front - Rear - Left Side no Right Side
Middle Front - Middle Rear
COMMENTS :
SYSTEM USE APPROVED : YES NO
ar :Departed :
Bui d ng nspector
TOiN OF QUEENSBURY
BUILDING a CODE ENFORCEMENT
742 Bay Road
queensbury NY 12804
(51s) 761-8256
SEPTIC DISPOSAL. SYSTEM INSPECTION
Name J:
Location .
Date I.1_ _ AT Permit #
SOIL TYPE : Sand- Loam-ClaY-
Results of Percolation Test-
( if applicable ) Rate-Minute/ Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS : u -
mb f t .
Size - ._ ft .
Stone size Size e
PI G:
Bldg , o Tank .
BTnk — ---
Dist . tsox to Fi ld/Pit
Openings Seale ? Yes No arti al
LOC'.ATIoN/SEPA IONS : feet
Foundation to Tank feet
Foundation to Absorption feet
Separation o+ Pits ----ems No
Conforms as per Plot 'Plan
LOCATION OF SYSTEM ON PROPERTY :
( circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
commENTSM
----------------.
LC- A j� r4 rdle"
r L4
�I + I
.� 5 /
SYSTEM USE APPROVED : YES
Departed :
Building ni for
i w
` TOWN OF QUEENSBURY - 'vx
BUILDING B CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION � �
f .
Name
Location AASSE
Dane Te� -rmit # •` Z "'
_ .
SOIL tE: an Loam Clay_
Results of Percolation Test-
( if applicable ) Rate-Minute/ inch
TYPE OF SYSTEM:
ABSORP ION FIELD • 0
ta7 Len
Length of each r ch r
Depth o tren es 3
Size of a +�
SEEPAGE umber-
Size - ft . x ft .
Sto size Size ype
P ING*
ldg . to Tank
Tank to Dist . Box
Dist . Box to Field/P '
Openings Sealed ? Yes No Part a7
LOCATION/SEPARATION • feet
Foundation to Tank '� feet
Foundation to Absorption feet
Separatism of ePi Pits
of Plan a No
Conforms as p
LOCATION OF SYSTEM ON PROPER
( circle
Front Rear, Left Side - Right Side
Mi ddl a Middle Rear
COMMpITS
SYSTEM USE APPROVED : YES NO
Arrived:
Departed: �l{�-
Bui sung nspector
{ a
TOWN OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-92%
SEPTIC DISPOSAL SYSTEM! INSPECTION
Name (Cw
L. rC
Locations �-- -
Date Z' , Perini t W. -k`r711.
SOIL TYPE: Sand- Loam-Clay- `7
36
Results of Percolation Test-
( if applicable ) Rate-Minute/ inch
TYPE OF SYSTEM:
ABSORPTION FIELD : Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS : Number-
Size - ft . x ft .
Stone size iz
PIPING :
Bldg . to Tan
Tank to Dist .
Dist . Box to Tarn .
Openings Seale ? Yes Na artia
LOCATION/SEPA TIONS : feet
'Foundation to ank feet
Foundation to Absorption
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY :
( circle one )
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS :
cl'. �
SYSTEM USE APPROVED : YES NO
Arrived ` e
a
Depa ' y
B I ding nsp t r
{
0
Jill-ill
G.-
1i
1
Pill
11 Jill
"i have seen orr
ed, or believe 1 saw evidence
all obiects suchses; ill trees. fef%NM libc•*
shown cr+ this dt �o represent that i have
pe }lymea ;ta . s t forth on the diagram."
ram t S
SIGNAV� . - 446AE
TOWN OF QUEEN5E URY
BU;L DING & PT.
REVIEWED 6Y
DATE