97-710 CI'JI�TIFIC T OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date December 2 197
I 3
1. � � �
This is to certify that work requested to be done as shown by Permit No. 7�1°has been completed.
This structure may be used as a
SEPTIC ALTERATION
Location 10 LYNDON RD.
Owner NAGERTY o CEORGE &
By Order of Town Board
TAX .MAP NO. 56 . --4-3. 1 TOWN OF QU S DRY
Director of Building & Code Enforcement
BUILDING ,PERM1T
TOWN OF QUEENSBURY
VALUE $ 0
TitiU 56 —4,-3 WAR REN COUNTY. NEW YOR K
PERMISSION is hereby granted to , HAMM:Mr, DOGE &
OWNER of property located at 10 LYNDON RD_ Street,Road or Ave.
in the Town of Queensbury,To Constructor place a SEPTIC ALTERATIONI;.:....,...:
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. OWNERS Address is
::-HARGUERITE 10 LYNDON RD.
•• =e;*',.QUEENSBURY- NYeAl?.,12804,i,,,
2. CONTRACTOR or BUILDERS Name
CRANDALL4, ,CHRIS. ,
3. CONTRACTOR or BUILDERS Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
I 1 Wood Frame ( 1 Masonry ( 1 Steel ( 1
7. PLANS and Specifications
.:SEPSIC---,.ALTERATION,..AS,-PER:.:PLOT, PLA11SRECIEICATIONS68z
8. Proposed Use
" !:•!;:!IA.44)3Pgire@AUTBRATION4.4, ',-
$
•
PERMITFEE P'AID-t THI$13ERMIT EXPIRES -- • - 19
(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.1
•
December 97
Dated at the Town of Queensbury this - — - 19
.•
SIGNED BY for the Town of Queensbury
Building s • Zoning Inspectciri
Application for SEPTIC DISPOS M� ' P =
DEC 01 1997(
Town of Queensbury ermit No9 l�
A
Dept. of Community Development ' TOItv^' . ?.:
Building &Codes Office E3U ; ?Iitli,x1i`Ji_;s s i ij
742 Bay Road pc' Fee Paid $ipAlb
Queensbury, NY 12804
Location of property for installation: /t 1. i,..„ J 1 1 -
Property Owner's Name: G g 0'q c /1--f9 -t7L(1 ,
Property Owner's Mailing Address: S f/4-c
Installer's Name: CO-6114 41 ( . - na-Phone # ?I fig i
Number of bedrooms (if residential): 3 Total daily flow: 4"st)
(residential - compute @ 150 gal./bdrm.)
Topography: t, rolling, steep slope % of slope
Soil Nature: and, loam, clay, other /depth: istO l%-)
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? / - feet
Percolation test: not required, 6rrequired [rate min. per inch ]
Domestic water supply: municipal, I/well, other
If domestic water supply is a WELL, water supply from any septic absorption is /0 0) feet. .
PROPOSED SYSTEM
Septic tank:f,800 gallon (minimum size: 1,000 gal.)
Tile field: each trench ‘0 feet / Total system length: 320 feet
Seepage pit(s): number of `..1.—. ' / size each: ft. by — ft.
Size of stone to be used: # Z- / depth or thickness f feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
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 Ordinance. /
Signature of responsible person: ��� Date: [ �/ 'ti 7
IS 1Y\
TOWN OF QUEENSBURY
-- BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804 •
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name \\--Or �.
Location LO (prDateRA
\a-)s-cd Permit # 0 __ I D
SOIL TYPE: (E9-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIE : Total -ngt U
Length of each t nchTUTJS
Depth of trenches AIM
Size of stone -
SEEPAGE PITS: Numb:
Size - ft. ft.
Stone size
PIPING: S'ze Type
Bldg. to Tank e`,./S%/:1,1&
Tank to Dist. Box ) 0
Dist. Box to Field/Pi
Openings Sealed? (00No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan esS No
LOCATION OF SYSTEM ON PROPERT :
e one)
rout Rear - Left Side - Right Side
i e Front - Middle Rear
COMMENTS:
we„_ P t 0 Ai
SYSTEM USE APPROVED: NO
Arrived: • _
Departed: S �,�"
Building Inspector
/36
/� TOWN OF QUEENSBURY
•;/f��= BUILDING & CODE ENFORCEMENT
'Yi# �3 742 BAY ROAD
QUEENSBURY NY 12804
(518) 761-8256,
ARRIVE: [71. DEPART: INSP:
FINAI. INSPECTION REPORT - .RESIDENTIAL
DATE INSPECTION RE E T RECE D:
NAME
LOCATION 49 Z�fQ/'/J%-
DATE 41/4/ // PERM AT A ...A064;7/
TYPE OF STRUCTURE -_�
FOOTINGS FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING SEPTIC INSULATION
FINAL ELECTRICAL WOODSTOVE OR FIREPLACE
N/A YES NO
CHIMNEY HEIGHT/B NT/HEIGH
PLUMBING VENT
ROOFING
EXTERIOR FINISH
DECK/PORCH/STEPS/RAI INGS
RELIEF VALVES
FURNACE/HOT WATER OPERATING
INTERIOR TRIM/PRIVACY DOORS
FINISH FLOORS:
BATH/KITCHEN WATERTIGHT
OTHER FLOORS 'SWEEPABLE
•
OTHER FLOORS CARPETED
STAIR CLEARANCE/RAILINGS
SMOKE DETECTORS
BATHROOM FANS
PLUMBING FIXTURES
FOUNDATION INSULATION
GARAGE FIRE PROOFING
DOOR CLOSERS
FINAL ELECTRICAL
•
SITE PLAN/VARIANCE REQ.
FINAL SURVEY PLOT PLAN
OK TO ISSUE C/O OR C/C
ou,i_ 60.er. rric
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