1990-273 r
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date I 11,1 1 19 _
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I I C21:-42
This is to certify that work requested to be done as shown by Permit No.9I)-27
has been completed.
sewage alteration
This structure may be occupied as a
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Location / rnitntrAr rninarm
Owner Guy Clunis
By Order Town Board
TOWN OF QUEENSBURY
1 a. J (I; _ 411
Director of Bldg. be Code Enforcement
. BUILDING PERMIT
TOWN OF QUEENSBURY No. 90-273 4
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to C;TTY CT,TTNTS
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OWNER of property located at Country Colony Drive Street, Road or Ave.
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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.
1. OWNER'S Address is
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2. CONTRACTOR or BUI LDER'S Name
Queensbury Sewer ,c
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
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5. ARCHITECT'S Address `<
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6. TYPE of Construction— (Please indicate by X) d
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( )Wood Frame ( I Masonry ( )Steel ( )
7. PLANS and Specifications
No. Sewage alteration to include 1000 gallon tank; 2 8'x8' Seepage pits with #3 stone
at 2 ft depth as per plot plan, specifications and application.
8. Proposed Use
Sewage alteration
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 10 19 92
(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.)
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Dated at the Town of Queensbury this Day of , 19 g0
SIGNED BY � �/ for the Town of Queensbury
Building and Zoning Inspector
LI VI,IV up Qui.ItiNsliUt:Y
,4/5 :"<". APPLICATION FOR d /
SEPTIC DISPOSAL. P 'I.; MIT ,j- 41ti 9F OiJ z..,,..
4 i- 3-5
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,��4111110
,/ MAY -9 .1990. .
<\`-\'L- 0 BUILDING DATE & CODE OD-
LOCATION OF PROPERTY FOR INSTALLATION CO(AAA—kit/ I16
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Owner's Name: �C--1 -h-hh.3 Telephone: r
Address: . YvL---Q
Installer's Name: O C-t..e..k2--(,LS l lc 7 `( Telephone: _2 36. 0
Number of bedrooms (residential only) 3
Total daily flow (compute Cd 150 gal per bedroom) Z.:r^-
Topography: Circle.one/K Rolling Steep Slope % of Slope
Soil Nature: Circle one:qM Loam Clay Other /Depth: Feet
Ground Water: At what depth? Feet
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle one: of require required rate min. inch.
Domestic water supply: circle one: Municipal Other
If domestic water supply is a well:
Separation: Water supply from septic absorption //7- feet
PROPOSED SYSTEM: Septic Tank d71 gal. (minimum size: 1.000 gal.)
TILE FIELD: Each Trench feet/Total system length • feet
SEEPAGE PIT(S): Number of -- / Size each_f—feet by Afeet
Size of stone to be used# 5 /Depth or Thickness 622 l feet
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I have read the regulation on the reverse side of this sheet and agree to abide by these
and all requirements ofthe Town of Queensb Sanitary Se �;e Dis sal Ordinance.
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SIGNATURE'OF RESPONSIBLE PERSON: -
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DATE: -- �� 91 •
OVER
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Septic -System Inspections:
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A.: ; All applications for septic system installation. alteration or repair,
-->as: reyuredDWt'te`=Town of Queensbury Sanitary Sewage Ordinance, shall
be..:submi•tted to the Building Department at least 24 hours before start
of construction and shall include a plot plan showing: •
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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.
cile fields and/or drywells
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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 co $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may
result in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installa—
tion, alteration or repair of an approved system, a new proposal must
be submitted to the Queensbury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads •
Queensbury, New York 12804
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Runt;irks: • .
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Jown ol Queeni4ur,
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BUILDING and ZONING DEPARTMENT ` j
Bay and Haviland Road, R.D. 1 Box 9,hs'Z
Queensbury, New York 12801
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SEPTIC DISPOSAL SYSTEM INSPECTION .
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NAME &LI/ Nui.vitil ' /
LOCATION i}
4k-we 0 kLI
DATE ,1-/I/ /qv! PERMIT NO. ' CO-1`
SOIL TYPE 0. - Loam - Clay -
Percolation Test Required? YES 4 NO
Percolation rate - Min/Inch I .
TYPE of SYSTEM:\
Absorption field, total length
Length of each trench ' /
Depth of trenched ' ,�'
Size of gravel i / . _
SEEPAGE P ITS4Numlber of) 2 j
Size- 4 ft. X iR ft. Cv-c2 's, .
Gravel size .05)1
PIPING: 1 Size, Type
Bldg. to tank '$
Tank to dist. box .k .,; )' • AeG
Dist. box to fieldt/pit " X`/'�,
Openings sealed? " ES • NO Partial
LOCATION/SEPARATIONS:
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Foundation to tank k AD ft.
Foundation to absorption Ae9 ft.
Absorption to lot line �.0 ft. ,
Separation of pits X � ) ft.
LOCATION OF SYSTEM ON�PROPERTY(circle one) •
�onde- Rear - Left is
- Right side -
COMMENTS: .q
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6.6,4, , . \
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SYSTEM USE AP• l
ROVED ° o
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Bu d 7 . Inspe\for
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MAY -9 1990
BUILDING & CODE u .
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