91-306 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date May 20 iq 91
This is to certify that work requested to be done as shown by Permit No. 91-306
has been completed.
This structure may be occupied as a Septic Alteration
Location dower Lane
Owner Harold Hayward
By Order Town Board
TOWN OF QUEENSBURY
A 7Q747
Director of Bldg. (Sc Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY a
No. 91-306
WARREN COUNTY, NEW YORK ,aox
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PERMISSION is hereby granted to Harold Hayward
OWNER of property located at Mayflower Lane Street,Road or Ave. 0.'
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in the Town of Queensbury,To Construct or place a Septic Alteration f+
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
2. CONTRACTOR or BUILDER'S Name a
Queensbury Sewer
sv
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name r
CD
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CD
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) fD
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( )Wood Frame ( ) Masonry ( )Steel ( ) •
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7. PLANS and Specifications
Septic alteration to include: ti
No. 1000 Gal Tank with 120' Tile Field Using f2 Stone, 10" Thickness
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 15, 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 thiss,.._.-nth Da o Play 19 91
SIGNED BY for the Town of Queensbury
Building and Zo 'i Inspector
TOWN OF QUEENSBURY
cARY APPLICATIO1 FOR SEPTIC DISPOSAL PERMIT
DATE: c;\L -- (7(
LOCATION OF PROPERTY FOR INSTALLATION !/ r t e 4f('( e , ( Cf Gt
Owner' s Name: /1C-1: wry-6)
Address: C G
Installer' s Name: Telephone:
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) LS—C)
Topography: Circle one: F1� Rolling Steep Slope % of Slope
Soil Nature: Circle one: and Loam Clay Other /Depth:
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what depth? TOW1*ithQUEENSBURN
RECEIVED
Percolation test: Circle one: !Ii_ftzallii0 required
MAY 141991
Rate - Min. Per Inch
Domestic water supply: Circle one: Municipal Wel Other BLDG. & CODE DEPT.
If domestic water supply is a well :
Separation: Water supply from any septic absorption %20 feet.
PROPOSED SYSTEM: Septic Tank ,"e7 -_ ,--Z) gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench / feet/Total system length ,/ 2„6 feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used #. r 2 /Depth or Thickness l feet
*****************************
HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal .
*Alan system and associated electrical work to be inspected by an approved
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: r DATE:
. .
ptiC System Inspections:
A. All applications for septic system installation, alteration or repair,
as required by the Town of Qucensbury Sanitary Sewage Ordinance. shall
be submitted co the Building Department at lease 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 drywalls
B. No system shall be covered before inspection and approval by the
uuild ing Inspuctor. 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 co produce said plot plan at cilia of inspection may
result in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installa—
tion, alteration or repair of an approved system, a new proposal must
bit submitted co the Quuensbury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queeensbury, New York 12804
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awn o ueensbur,
BUILDING and ZONING DEPARTMENT
�\' Bay()a nud
and Havilandueensbury New RoadYork, R.D.12801 1 Box 98
,
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME WO.N(C) , t \(:) k'
LOCATION rI\ tOcut',YY atl'-,
ur -
DATE .5 / lbPERMIT NO. 7/v -30
(r
SOIL TYPE - .and Loam - Clay -
Percolation est Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length `r/ -?
Length of each trench 4/0 ,'
Depth of trenches 1
Size of gravel_ .2
SEEPAGE PITS{Number of) _
Size- ft. X ft. ,
Gravel size , /
PIPING: ize Type
Bldg. to tank /`4 P U L
Tank to dist. box / 1 i/
Dist. box to field/«it y `7
Openings sealed? 4200 NO Partial
LOCATION/SEPARATIONS:
Foundation to t1ik j g ft.
Foundation to adsorption 02y ft.
Absorption to of line p'?t7 ft.
Separation of/pits ft.
LOCATION OF STEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS: ac
i
t
SYSTEM USE APPROVE YES N
Bui in Ins ector
01/86 and vl
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_Jotvn o� Queen i urcy
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME \Joy /1I\/Lt ki`c) 1)a✓oiG
LOCATION 1//�✓cc . '1//OCA tez,'
DATE 5 / ,. PERMIT NO. 9 ,/ 3 ('h(G
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 PITS4Nuinbe f)
Size- ft. X _ ft.
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist box
Dist. box to field/p
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:
AO '74 v4;17 /00,..e,Ar.4)//41t
/t/ery 7a;i fa%" tae -1
SYSTEM USE APPROVED YES N
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/a_IcrC) Building Inspector
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TOWN OF OUEEN$BURN
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RECEIVED
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MAY 14 1991
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TOWN OF ("3"r":AlsrturY
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REVIEWED BY •iii/ I
DATE _ c5/../1 :
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