94-526 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19
September 29 —T94
This is to certify that work requested to be done as shown by Permit No. 94526
has been completed.
This structure may be used as a SEPTIC
Location 2330 RIDGE RD.
Owner ALFRED KLEEMAN
By Order of Town Board
TAX MAP NO. 21. -1-22 TOWN OF QUEENSBURY
4-t;/\'
Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No. qi-1 -5 a(40
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to A) 1'.ed h beern Ln
OWNER of property located at ()p p.)r 2_) Ed Street,Road or Ave.
in the Town of Queensbury,To Constructl or place a t1! 5rif(_.
at the above location in accordance to application together with plot pl ns and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
Upper Edge Pd
2. CONTRACTOR or BUILDER'S Name
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
1 )Wood Frame ( ) Masonry ( 1 Steel ( )
7. PLANS and Specifications
No.
8. Proposed Use
epii 'sue1L
$ ,ob PERMIT FEE PAID —THIS PERMIT EXPIRES 47-AO 19 q5
(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 Day,o P1 19 (14
SIGNED BY for the Town of Queensbury
Building and Zoning` nspector
/—d)ick'lf
'A eAT(of OF 'QUEENSBURY
APPLICA-Ipl ', EPTIC DISPOSAL PERMIT Permit #
� %G�?r�o �se Fee Paids
tkr
Date: ✓ l Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: ,Pei '€ of ,Q
f
Owner' s Name: - L 1 &ct.)
Owner' s Mailing Address: e0"...Leess u 4l C
Installer' s Name: (7), hone #: 77-236-iit
Number of bedrooms (if residential ): _�-
Total daily flow (residential-compute @ 150 gal . per bedroom) : 07)
Topography-Circle One: Flag Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loa Clay Other /Depth:
Ground Water-At What Depth? 6 11 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 Other _
If domestic water supply is a well -
Separation: Water supply from any septic absorption (/o feet
PROPOSED SYSTEM: Septic Tank /Oat)
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 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: DATE: / ��
1'1'
TOM OF QUEENSBURY 0.2 g0
BUILDING & CODE ENFORCEMENT 3 C2
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
��f� 1/F'-e/- .—
Name .air —�
Location �'/ '�-
Date /', -- fr Permit # qij 50(p
SOIL TYPE: San• -?oam-Clay-
Results of Perco .tion Test-
(if applicable) R.te-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trenc' C.). /,
Depth of trenches c �f-R r• f)
Size of stone 2--
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Sze Type
Bldg. to Tank a%,;.L.
Tank to Dist. Box �- / ; :_
Dist. Box to Field 'i /))'c.
Openings Sealed? es No Partial
LOCATION/SEPARATI"� Sr
Foundation to Ta feet
Foundation to Ab.orption feet.
Separation of Pits eet\
Conforms as per Plot Plan Yes No
LOCATION OF SYS EM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Sid-
Middle Front - iddle Rear
COMMENTS:
1(
it? ,--,/ (..2-7j,",- /11/c," e:511 ,,:,....._
r i /
r / /) V
SYSTEM USE APPROVED: 7 7YES2 NO
Arrived: r .,
Departed: , 1
I
Building Inspector
d�
0/4
p
20
—A
X,177IN
V L ;00%
13"
INLET110,
01�
6UTLETS-T(VE 4"'
n
stibutio BOX,:'
24 TAPERED HOLE & PLUG
IL
4
?/re.009
�750 GALS' im) GAI_.
41-SH
r jj��". 1 . 1 11 1 1 . I..�I
5
4'
1006 IbAL
8' 20
Ae
760 GAL
-5-, 77
J-;oc,7-
GAL,
LIQUID
00,0,�rlel .1;9111-111�0
LE\1 L
10' 2
OW ro e
f i 1 8 t Ta
T
a i age d itch to '
k w a t r
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ng, e p g r o u n d
t grad e 16 'e 1
1 e tbe low&S v
app r ox,imAte y 6 'b 1 6 T4
ff ueh t-
2. ep t em 'des ign s �b as ed u 0 s th'L,e
S t ic p n ab orp n bed w i
Sq t MaX� in
ap pere,,.rate 2.n
p I icat ion rate of GPD 'per
14_�Iz z Z74rll-
e p
0,r e im'p' orted f i:I I to b need e I ow the �be
d
d as a i'acharje r 8.te of� 3 GPD an
A r 6 o m 'd 00
beid
.'7
r e-q i e a a 0 t 6 e d ar e a ofL 430sq 300
M'in-iMUM b s rp i 'n b-
U'
d
s with�L, apere oeL
a b-62�d.�of - 20ft . 22f t m in. -length t
e
_L t f at least t 2.1- - a
a r 1.
arb6nd t'h6 'bed erime er o -to be
Mb twe//f 4�01 24 p
2f t 'epatat i6ri
min imuM of 1_2f t. ben eat h bed to guarentbe
gZ-
we en bed �bottom and ground
'Water
bet
71ION
t t I�IV V14�W7, o Z. i e is discharge 3.n tri nAerdron
xi
s t i h 9 s e 0 e n'
pre-f abrieated f iberglass collection biasin �:vith' a 'SeWage'00�
An -66 c ep t ab�l e
g 'Maximum' of o 1 id 6 e
Capab I e o handlin X�e;p 14eOp -rO/14 s e a Goulds Simplpx System 'with a '24 sewage,.basin
�'GoUldSL Mod
OL887 �sewage
w i t b p u in t, No
e
e I
e c d
�'VS103 1 1B 1/211P "-'and e 1 at' d ontrols Polyethy ene' �2
-pi e can - the
'd c e
be a bet" een '-the . 611 cti.on basih,,pump' �Ind
p u e u n
-septic, tan lt -"do e*' discharge
This syste will r e- in
M Su
0 W
d'.
j�t6mr 0
L p -16 s t concrete be a b er o or
40 4L s sup I ied
119 re a C
C) 6 y
prov6d equal.
+ ap
Clio lt� d
6 the 't an k b e' - -pum regg ar
out at
ended that sept c pe
0 to �piev6n t, e C
as r eq U r ed ariy-.ovet of....solids' to
QU E E14 SB U Ry
TOWN OF
:,the abs'orption"bed
T.
BUILDING & COD, 7 . be �,f lled and abandoned
T lie xisting ry�-we 1.1 'is Lo
REVIEWED BY
mourGomERYlk
DATE wiujw
00 IV I; CONSULMNGENGINVER
P0,
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