1990-448 CERTIFICATE OF COMPLIANCE
TOWN OF .QUEENSBURY
WARREN COUNTY, NEW YORK
Date July 13 19 90
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This is to certify that work requested to be done as shown by Permit No. 90-44.R
has been completed.
This structure may be occupied as a sewage alteration
Bay R & Moonhill Road
Location �� (/
CLEVELAND AND LOREN DN
Owner
By Order Town Board
TOWN OF QUEENSBURY
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Director of Bldg. & Code Enforcement
BUILDING PERMIT y
TOWN OF QUEENSBURY No 90-448
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to LORENSEN & CLEVELAND
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OWNER of property located at Corner of Bay & Moon Hill Roads Street, Road or Ave.
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 t"
Bay Rd/Moon Hill Rd.
Queensbury
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2. CONTRACTOR or BUILDER'S Name
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Queensbury Sewer tt
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
5. ARCHITECT'S Address ca
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6. TYPE of Construction— (Please indicate by X) p,,
( 1 Wood Frame ( 1 Masonry ( 1 Steel ( 1
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7. PLANS and Specifications
No. Sewage alteration to include 1000 gallon tank, one 8'x8' Seepage pit with
#3 stone at 2 ft. depth.
8. Proposed Use
Sewage alteration
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$ 2F_nn PERMIT FEE PAID —THIS PERMIT EXPIRES July 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.) 'c75•
Dated at the Town of Queensbury this 10th Day of q July 19 90
SIGNED BY for the Town of Queensbury
Building and Zoning Irl ctor
�` � � � PLICA TOWN OF QUEENSBURY
AP TIOH FOR EPT C DISPOSAL PERMIT
I ' -e-DATE: Li, Iii-i 1-- 'to [] -.... i ' l ' i>
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LOCATION OF PRORERTY FOR INSTALLATION gCi-L_ JP 4 " iUt 7 0139 / 'v_
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Owner' s Name: ve�crr4c,( /'"_�?.1A—�->--a-'.nDIL_DINGEi: CODE DEFF,
Address: �i7-r—Pr.L,Ui D d Moon hilt Rd
•Installer' s Name: 14 0� azriit-c- 12)c4r Telephone: G g�'23 ,Y
Number of bedrooms (residential only) /
Total daily flow (compute @ 150 gal per bedroom) •3 4Z3
Topography: Circle one: Flat Rolling 4Steep1S1 % of Slope
Soil Nature: Circle one: J Loam Clay Other /Depth:
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what depth? Feet
Percolation test: Circle one: cnot requite required
Rate -- Min. Per Inch -
Domestic water supply: Circle one: Municipal (Mil) Other
If domestic water supply is a, well :
. Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tankeel0 gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE, PIT(S): Number of ,� feet
/Size each
by - feet
/
Size of stone to be used iv /Depth or Thickness feet.
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HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal .
*Alarm 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: kl \--��'1 DATE: a,°-// i
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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 co lot lines
3.) location and distance to structures
4.) location and distance co any water supply
5.) size and dimensions of all tanks, distribution boxes,
aile fields and/or drywalls
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 $250.00.
C. An approved copy of the. plot plan shall be available on the construction
site. Failure co produce said plot plan at time of inspection lay
rusulc in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper /nscalla—
cion, alteration or rupuir of an approved system, a new proposal must
bo submitted to the Queensbury Building' Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
. Queensbury, New York 12804
lain r k s: ,..
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awn of Queen Jtur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC k'ISPOSAL SYSTEM INSPEC +ION
NAME ta,,,-.":4-..V.0-7.-7./
LOCATION Z; / ,,1
DATE T // / PERMIT NO. C/l ' ' 44 S?
SOIL TYPE - end 1 Loam - Cla i - '
Percolation T= t Required? Y:S - NO
Percolation rake - Min/Inch
TYPE of SYSTEM
Absorption fie total le %th
Length of each ` rench
Depth of trench!ls
Size of gravel .t
SEEPAGE PITS4N ' •e of)
Size- 7 ft. X k;... ft. ;6,) ,3 ' ,4=ma4
Gravel size , . .
PIPING: 1 ' ze Type
Bldg. to tank 1 ;, ' �zJt
Tank to dist. box ' 4/'' /O</C
Dist. box to field pi:` y" �/!�c
Openings sealed? t r.0 NO Partial
7'
LOCATION/SEPARATIONS' :
Foundation to tank ', /® ft.
Foundation to abso •V ion `J ? 'ft.
Absorption to lot lilie j(2 ft.
Separation of pi — ft.
LOCATION OF SYST;' 0 '. PROPERTY�-c-trrle one)
Front - Rear - ,-ft s de - R fight_ side 2
COMMENTS:
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SYSTEM US APPROVED • ,0
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Building1 In .pector
01/86 and vl
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6 `/&/` .$>:4/
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