92-102 -
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date `11())L i .g r 19 22-
This is to certify that work requested to be done as shown by Permit No. 92-102
has been completed.
This structure may be occupied as a Septic Alteration
Location Star Route, Ridge Road
Owner James Palmer `'
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 92-102
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Jim Palmer
OWNER of property located at Star Rt Ridge Rd Street, Road or Ave.
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in the Town of Queensbury,To Construct or place a Septic Alteration c.
at the above location in accordance to application together with plot plans and other information hereto filed and 9
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. w
1. OWNER'S Address is
Same
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2. CONTRACTOR or BUILDER'S Name 7p
R.A.M. Transport `+
to
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) e+
A .d.
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( )Wood Frame ( )Masonry ( )Steel ( )
7. PLANS and Specifications
No. Septic alteration to include: 1000 Gal. Tank using #2 Stone,
1' Thickness as per plot plan specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES March 30, 19 94
(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-)
Dated at the Town of Queensbury I I Da of March 1992
SIGNED BY for the Town of Queensbury
Building a .i oning Inspector
Ir a TOWN OF QUEENSBURY TOWN OF QUEENSBURI
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # EIVED
Fee Paid -
,s� MAR 3 0 1992
/
Date: c �3'O/ pC Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: (lite fPcP, BLDG. & CODE DEPT.
Owner' s Name: jJim' ? /I1,(
Owner' s Mailing Addre s: c9i 9/i £4 ' �Y'4 su s
Installer' s Name: yA_A4 1./veivipt-/ Phone #: "/-2 -Qfc dvAix4/
Number of bedrooms (if residential ): 41/eK
Total daily flow (residential-compute @ 150 gal . per bedroom): 4,
Topography-Circle One: Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal VII0 Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank jCuV gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s): Number of / Size each: ft. x ft.
Size of Stone to be used: # , / Depth or Thickness 414 feet
**************
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks Size\of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
agency.
****************
I have read the regulation on the reverse side of this sheet and agree to abide
by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: 1* IKk 462 DATE: cT l30/Z67
awn of Queeniur , ,/,2
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98 _
7.
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME l /) /C7�':974.1-�r/
LOCATION/ /6/ /L/il �G ll 6,
DATE 31 / ;ti PERMIT NO. -/0
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches '
Size of gravel
SEEPAGE PITS{Number of)
Size- ft. X _ ft.
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box
Dist. box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption ft.
Absorption to lot line ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS:
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SYSTEM USE APPROV S N
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.4A TOWN OF QUEENSBUR
RECEIVED
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MAR 3 0 1992
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\V,L BLDG. & CODE DEPT1
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TOWN OF QUEENSBURY ,
BUILDW3 & Cr%r=t„,„*--„ ) DEPT,-
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REVIEWED
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