91-795 40
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEWT YORK
Date hrYenata c' 19 1/
This is to certify that work requested to be done as shown by Permit No. 91-795
has been completed.
This structure may be occupied as a Septic Alteration
Location Hall Rd
Owner Daniel R. Barber
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-795
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Daniel Barber
OWNER of property located at South side of Hall 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
RD#5 Box 119
Queensbury, NY 12804
2. CONTRACTOR or BUILDER'S Name
Same
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel (
7. PLANS and Specifications
Septic Alteration to include: 1000 gal tank with 2 seepage pits
Noeach 8' x 4' using #3 stone, 2' thickness as per plot plan specifications
and application
8. Proposed Use
,ti
Septic Alteration
$ 25.00 PERMIT FEE PAID—THIS PERMIT EXPIRES November 13, 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 13th Day of November 19 91
SIGNED BY for the Town of Queensbury
Building and Zoning Inspect
I
c' stENSB
� TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # //-7I5
N O V 8 199iee Paid ( S
Date: 7 ( rino. & cocntotemd By
LOCATION OF PROPERTY FOR INSTALLATION: S� A u 9 14,A iE
Owner' s Name: PA-/ ) J r L / A-
Owner' s Mailing Address: 0 ql 0 y/ scg
Installer's Name: Phone #:
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom): �7 is^C7
Topography-Circle One: Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand oam ) Clay Other /Depth:
Ground Water-At What Depth? CD Feet
Bedrock or Impervious Material-At What Depth? ei Feet
Percolation Test-Circle One: Not Requinad Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other t„-QS19,
If domestic water supply is a well -
Separation: Water supply from any septic absorption 1 00 feet
PROPOSED SYSTEM: Septic Tank looa gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s): Number of Q / Size each: ft. x l ft 01
Size of Stone to be used: # , / Depth or Thickness / feet 'a - x
�
************** 'WY
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 the Town of Queensbur Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: j DATE: 1r c( 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:
47e1 /few/ 51e- 6t-- , ‘17/6e-/
own of Queen i urcy 1
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTICAlgykaiLl
DISPOSAL SYSTEM INSPECTION
NAME LOCATION ,
DATE /// / / PERMIT NO. 31 /
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 -----
Absorption to lot line ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - tight side -
COMMENTS:
ct ;; -a f A„ L.: 6 ! I I.
I�,-�-i (3 12 h�L— elet RI r L 6 f it,
f"T(S+_ I,. v )Ems' I j ,.‘ k„'IC. ,
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SYSTEM USE APPROVED ES..` N0
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Building In actor
01/86 and vl
CS-LW/00d 0qC'1E1 CO z/1.OTatiC/27 UEENSB .
BUILDERS, DEVELOPERS & RENTAL UNITS
R. D. 1, GLENS FALLS, N. Y. 12801 t )V 8 1991
DANIEL R. BARBER, Pres. ('l_DC, & CQDE DEPT.
Tel (518) 798-4252
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