1990-546 CIS` A'✓.- �, .A > ` t : S
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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date August 23 19 90
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This is to certify that work reques ed to be done as shown by Permit No. 90-54S
has been completed.
This structure may be occupied as a sewage alteration for system
Location 2-"A - 1 Aviation Rd
THEODORE S & ELIZABETH BROWN
Owner
By Order Town Board
TOWN OF QUEENSBURY
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Director of Bldg..& Code.Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No 90-546 •
WARREN COUNTY, NEW YORK 1-3
PERMISSION is hereby granted to THEODORE S BROWN
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OWNER of property located at 179 Aviation Rd Street,Road or Ave. Z
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in the Town of Queensbury,To Construct or place a Sewage alteration
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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. col
1. OWNER'S Address is
same
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2. CONTRACTOR or BUILDER'S Name C
Sanitary Sewer
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
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( )Wood Frame ( ) Masonry ( ) Steel ( )
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7. PLANS and Specifications
No. Sewage alteration to include 1000 gallon septic tank, 180 feet of tile field
with #2 stone at one foot depth. -
8. Proposed Use
Sewage system
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES August 21 19 92 p'
(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 21st Day of August 19 90
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SIGNED BY � CJ' �� for the Town of Queensbury
Building and Zoning In ctor
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4flsn - 7- D TOWN OF QUEENSBURY X?-----./24-i
Alt f APPLICATIOf1 FOR SEPTIC DISP
`DATE: C /- 90 ,• I ' Ir 1�
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LOCATION OF PROPERTY FOR INSTALLATION / 9 9 (//l e --
I' ab Owner' s Name: QSS of 0U A) .
'i INS8: CODE CG-. .
N Address: 1 -7 q /411// '/vny /e0
Installer' s Name: cJ J /7A2 64-4J I Telephone:792— 72 c- '
Number of bedrooms (residential only) 2
Total daily flow (compute @ 150 gal per bedroom) n
Topography: Circle one: 41111P Rolling Steep Slope % of Slope
Soil Nature:- Circle one: fir-- -Loam- Clay Other --. /Depth:
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what depth? Feet
Percolation test: Circle one: (,!lot require required
Rate - Min. Per Inch
Domestic water supply: Circle one: lunicip-a.b Well Other
If domestic water supply is a, well :
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank /0 0 ) gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench 60 - feet/Total system length f S16 feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size .of stone to be used #. /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 o he Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: DATE: (9-'l; —Tit)
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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 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 loc lines
3.) location and distance co structures
4.) location and distance to any water supply
5.) size and dimensions of all tanks, distribution boxes,
tile fields and/or drywalls
B. Nu system shall be covered before inspection and appiroval 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 may
result in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installa—
. cion, 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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Remarks: •
1 00 6vL,KA I O
_locun of ueeniburt (21'JL
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYST INSPECTION
NAME ! ,.5 61_ CJ`l�
LOCATION\ 191 6 L. -.. d .
DATE 0 i 24\/06 PERMIT , 0.q0--.54-6
SOIL TYPE Sand - Loa - Clay -
Percolatio Test Requ'red? YES - NO
Percolatioh rate - Mi /Inch
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TYPE of SYSTEM:
Absorption field, t.tal length ` S-(i
Length of e ch tren h (-/ s
Depth of tr-nches ' Z- ,T,. .
Size of gra el_ rI "�
SEEPAGE PITS Numbe of)
Size-
- f
Gr. - size
PIPING: Size Type
Bldg. to tank'
Tank to dist. \bo
Dist. box to f�}'eid/pit
Openings sealed. YES NO Partial
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LOCATION/SEPA•, IONS:
Foundation to , nk ft.
Foundation to :b orption ft. Q IC
Absorption to log line ft. -
Separation of pit. ft
LOCATION OF S) ST ON PROPERTY(circle one)
Front - Rea - Lef side - Right side =
COMMENTS:
SYSTEM US APPROVED , •
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