91-653 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date ,l/r f2f,0, /2 ,/,19 t/
This is to certify that work requested to be done as shown by Permit No. 91-653
has been completed.
This structure may be occupied as a Septic Al tar/Man
Location RD#1 Box 1657. Macy Rd„ Lake George_ NY 12R4S
Owner James & Noma Hearns
By Order Town Board
TOWN OF QUEENSBURY
(3;1"
Director of Bldg. ac Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-653 0
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to James & Norma Hearns
OWNER of property located at Racy 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
Same fD
N
2. CONTRACTOR or BUILDER'S Name Cr
Sanitary Sewer
3. CONTRACTOR or BUILDER'S Address
0
4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
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( )Wood Frame ( ) Masonry ( )Steel ( ) e+
t'D
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7. PLANS and Specifications
Septic Alteration to include:
No. 1000 Gal. Tank with 1 seepage pit, 10' x 8' using #3 Stone
2' Thickness as per plot plan specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES September 16, 19 93
(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 this 16th D. )of Se'tember 19 91
SIGNED BY -/ for the Town of Queensbury
Building and Zoning I =.-ctor
Aggh
‘4,747 TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # ii --CD S 3
Fee Paid
--
Date: Reviewed
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LOCATION OF PROPERTY FOR INSTALLATION:
Owner's Name: J,`Iir) S -4- A/OR/1M itli RR.A/S
Owner' s Mailing Address: R,,Z). gox /45'7 / /i//9& �'� � AK� C` RG' /11,�/.J gi�3
Installer' s Name: .) AN .b.REAL®..3 Phone #:
Number of bedrooms (if residential ): 02
Total daily flow (residential-compute @ 150 gal . per bedroom):
Topography-Circle One: Flat Rolling Steep Slope % of S,l opk“ OF (=- --0,e<
RECEIVED
Soil Nature-Circle One: Sand Loam Clay Other /Depth:
Ground Water-At What Depth? Feet SEP 12 1991
Bedrock or Impervious Material-At What Depth? Fe' & CCADE DEFT.
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank AVE) gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s): Number .of / / Size each: /0 ft. x ft.
Size of Stone to be used: # 3 / Depth or Thickness 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: '71b4,rna.- , / DATE: 9// /11
• f
Septic System Inspections:
A. All applications for septic system installation, alteration or repair,
as required by the Town of Queensbury Sanitary Sewage Ordinance, shall
be, submitted to the Building Department at. least 24 . hours before start
of construction and shall include a plot plan showing:
1) the proposed location of the system
2) location and distance to lot lines
3) location and distance to structures
4) location and distance to any water supply
5) size and dimensions of all tanks, distribution boxes, tile fields
and/or drywells
B. No system shall be covered before inspection and approval by the Building
Inspector. Failure to comply with this requirement may result in the
uncovering of the system by the installer and a fine of up to $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
Town of Queensbury
Building & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks:
own Of Queensbur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road;R.D. 1 Box 98 •
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME /fcli/•t1
LOCATION C4, fe,
DATE 9%J/9/ PERMIT NO. gif`‘'
SOIL TYPE Clay -
Percolation est Required? YES (NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total le ter
Length of each t nee 1--
Depth of �tr-�nc•h es " /(f /d
Size o "gravel ('
SEEPAGE PITS{Nuinber of) !'
Size- `ft. X\lO ft. ,cygft41/4.:I- S.0 Wit:!-
Gravel size
PIPING: ? Size Type
Bldg. to tank \ ( 56:A tio
Tank to dist. box j L q9��
Dist. box to fic .d/p'openings sealed? E s NO Partial
LOCATION/SEPARATIONS;
Foundation to tank fi !® ft.
•Foundation to absorption \:,7c ft.4-- •
. Absorption to•lot line '/0 ft.
Separation 'of pits ft.
TON OF SYSTEM ON PROPS TY(circle one)
Front ' Rear - Left side - Right side -
C ENTS:
•
SYSTEM USE APPROVED YES NO
Bui ding I spe tor
01/86 and vl
._ - _ .- ..- - CRUSHED
- - •- - S ONN BACKTh_
�04 I I
! ....AV••yy OIjf`• �
LEACHING PIT DETAILS
r,, :":'- / 1
9 LANDS OF
o' DUTRA
X F
witzarzr_mai
•
%,GARAGE
h / -�Mc hOUSF Lk_`�7{�
, 60
e'/ /1: :: '
: HOUSE aC S E O ,� STAIRS 1 oocc
-':"AlaM., ,,. 7O
_ -- 150.00'
/ STAIRS
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I
HOUSE 1i
-
APPROX.LOCATION C��
LANDS OF
DICKINSON
NOW:
°POSES SEPTIC SYSTEM
IN AREA OF EXISTING SYSTEM.