93-544 +1 �P: - - -
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44.
CERTIFICATE OF COMPLIANC
E
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date ,4i, t / 19 I..
This is to certify that work requested to be done as shown by Permit No.93-544
has been completed.
This structure may be used as a septic system
Location 6 Richardson Street
Owner Richard Mattison
130-2-6 By Order of Town Board .
TOWN OF QUEENSBURY
42,ttei Wohicy
Director of Building 6 Code Enforcement
BUILDING PERMIT
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TOWN OF QUEENSBURY No 93-544 0
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to RICHARD MATTISON N
OWNER of property located at 6 Richardson Street Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Septic alteration y
at the above location in accordance to application together with plot plans and other information hereto filed and 1-3
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. c
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1. OWNER'S Address is
7d
same
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2. CONTRACTOR or BUILDER'S Name
Smith' s Excavating
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name ()
W
SZ
5. ARCHITECT'S Address O
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( 1 Masonry ( )Steel ( )
7. PLANS and Specifications
Septic alteration to include 200 feet of tile field at
No. 50 ft. lengths with #2 st one at 1 s ft as
g / per plot plan,
specifications and application.
8. Proposed Use
Septic system C))
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$ 25 . 00 PERMIT FEE PAID —THIS PERMIT EXPIRES September 10 19 95
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
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town of Queensbury before the expiration date.) F,-
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10th September 93
Dated at the Town of Queensbury tJs— ay o 19
SIGNED BY ( for the Town of Queensbury
Building a Zo mg Inspector
s �y67 9'.41077 p�
� 0 TOWN OF QUEE uRY 4-I klAbak
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APPLICATION FOR SEPTIC DISP SAL PERKion ; ermit # 93 i,/9
fle„ ee Paid / S
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Date: i!///6!/4 ,s' gdg r , :' 'iewed y
LOCATION OF PROPS FOR INSTALLATIO : to
Owner's Name: J (1 / J56� .
Owner's Mailing Address: (ickk 5lr .
Installer's Name: ,5V/41) '3IjI' (Ia/1"1/7 Phone #: '%7g/3
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom): -./5C-D
Topography-Circle One: Flat 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 OneNot Required'-equired/Rate Min. Per Inch
Domestic Water Supply-Circle One: ci al cell Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank 'X/ / /al . (Minimum size: 1,000 gal . )
Tile Field: Each Trench 5) feet//Total System Length ;KZ feet
Seepage Pit(s): Number of / Size each: ft. x ft.
Size of Stone to be used: # 62 / 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 f Qu nsbury Sanitary Sewage D'sposal
Ordinance.SIGNATURE OF RESPONSIBLE PERSON: DATE: 73
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