1990-168 /J. V
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date April 26 19 90
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This is to certify that work requested to be done as shown by Permit No. CD - 168
has been completed.
This structure may be occupied as a Sewage &': ;'7 :3�?.`i
Location 6 Whipporwill Drive
Paul Van Amburgh
Owner
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 9 0-16 8
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to PAUL VAN AMBURGH
OWNER of property located at Whipporwill Drive Street, Road or Ave. r"
in the Town of Queensbury,To Construct or place a sewage 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.
z
1. OWNER'S Address is
same
2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer
3. CONTRACTOR or BUILDER'S Address
PO Box 224
Glens Falls NY 12801
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) fb
( )Wood Frame ( ) Masonry ( I Steel ( ) Gi
7. PLANS and Specifications
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No. Sewage alteration: 1000gallon tank, 2—see ' 'g p;;ge pits 8 x8 with #3 stone at
2' Depth as per application. -
8. Proposed Use
F o
Sewage alteration
25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 18 1992
(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 8th Day of April 19 90
SIGNED BY / for the Town of Queensbury
Building and Zoning n pector
TOWN OF QUEENSEURY
; ��_. APPLICATION FOR
.n� `v_ AP '1 P OWN OF CiUEEl�1SBURl
�� SEPTIC DISPOSAL PERMIT ,\,/ E+CEiVE.D"
APR 1 7 1990
DATE / -7 - 910 BLDG. & CODE DEPT.
LOCATION OF P PERTY FOR INSTALLATION Pizeozcee..d/(t// // Telephone:
Owner'shame. /,iit /�,�'r� �G'�l�U/Ld'�` p
Address: A/ i 0x J/%' Oil
Installer's Name: Aia i h:6,-„,4_ Telephone: 7 5;- 7d,5
Number of bedrooms (residential only) Lq
Total daily flow (compute (d 150 gal per bedroom) . '9 9
Topography: Circle one: a Rolling Steep Slope % of Slope
Soil Nature: Circle one d Loam Clay Other . /Depth: . Feet
Ground Water: At what depth? Feet
Bedrock or Impervious Material: At what depth? Feet - - - _
Percolation test: Circle one:. not required required rate min. inch.
Domestic water supply: circle one: blunicipai Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM: Septic Tank/ 000 gal. (minimum size: 1.000 gal.)
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of 2// Size each g feet by _j feet
Size of stone to be used #3 /Depth or Thickness _ feet
*************************
I have read the regulation on the reverse si of this s eet and agree to a ide by hese
requirements of the Town of uee sbur, Sanita y Sewage Di s 1 din ce.
and all R �
SIGNATURE OF RESPONSIBLE PERSON: Cart/°
Ae/ledq---
DATE: g..- l 9 -L .
OVER
1
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 co 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 installa— .
tion, 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 and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
Remarks: •
j1/0. I !(3°
. _Jown of ttQueen.ituru
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC SYSTEM INSPECTION
NAME (P4wu. A/0,,,,,..k i✓
, / pp�LOCATION �V in Ll r-14 bi
DATE 4; o3 / 1(0 PERMIT NO. 9a-1 11'
a'
SOIL TYPE - . ,� Loam - Clay -
Percolation TestjRequired? YES - NO
Percolation rate- Min/Inch . •
TYPE of SYSTEM:
t';
Absorption field,'+ total length
Length of each tr'ench •
Depth of trenches; '
Size of gravel'_
SEEPAGE PITS{Number of) - `�
Size- ft. X 8 ft. .1
Gravel size 64-1j r'
PIPING: , Size Type
Bldg. to tank ' "`
r:
Tank to dist. box
Dist. box to field/ ,
Openings sealed? ES F1O Partial
LOCATION/SEPARATIONS: e •
T
Foundation to tank ; 'fit,
'Foundation to absor"ptiori t.
Absorption to lot 4ne .' 7rift.
Separation -of pits . f(c7ft.
LOCATION OF SYSTEM ON PROPERTY(ci - - e)
Front - Rear- - Left ,sde - R . t side
•
COMMENTS: - i'"
ol
i7 t,
, i
•X
it
4w
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Y
10 SYSTEM USE APPROVED NO
404
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Buil. g I;spector
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API' 1388'
OWN OF OUEENSBLIRY
RECEIVED
APR 1 7 1990 0\
BLDG. & CODE DEPT.