1990-548 j _
CERTIFICAAE OF COMPLIANCE
:TOWN OF QUEENSBURY
I WARREN COUNTY, NEW YORK
Date August 29 19 a®
This is to certify that work requested to be done as shown by Permit No. 90-548
has been completed.
This structure may be occupied as a sewage altera7n for system
Hillman Rd, Cleverdale
Location
JOHN HICKEY
Owner
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. do Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY '
No. 90-548
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to JOHN HICKEY
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OWNER of property located at Hillman Road, Cleverdale 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
5 North Walden La
Troy NY 12180
2. CONTRACTOR or BUILDER'S Name
a
A.C.I. Builders
to
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) (�
( )Wood Frame ( ) Masonry ( )Steel ( ) C
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7. PLANS and Specifications (D'""'
No. Sewage alteration to include 200 feet of tile field as per plot plan, specifications
and application.
8. Proposed Use
Sewage system ro
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES Augsut 21 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.) O.
Dated at the Town of Queensbury this 91 st Day of August 19 90
SIGNED BY �'°l t� for the Town of Queensbury
Building and Zoriirrg Inspector
//'� o/ T• •• :,' ..� ENSB URY
APPLICAT, ON Fort /e� L PERMIT
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--W(9DATE: e/2.0,0' I c. I (,ikoui.
_LOCATION OF PROPERTY FOR INSTALLATION CL6i16e0..Le /// a' !VEy URY
��EE��ED
Owner' s Name: J6,�,v
AUG 0 1990
Address: 5` ti �)9za')Cti L�g�vE T.I,v 417 zl6'6
C,+ BLDG. & CODE DEPT.
Installers Name: 0i4oe,s Telephone: f's"G 2- 330
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) 3 cso
Topography: Circle one: Flat Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand Loam Cla Other /Depth:
Ground Water: At what depth? 577 Feet
Bedrock or Impervious Material : At what depth? Feet
•
Percolation test: Circle one-: e—required required
Rate - Min. Per Inch
Domestic water supply: Circle one: Municipal Well Other L-w
If domestic water supply is a• well :
Separation: Water supply from any septic absorption llo feet.
tX/ T 4/
PROPOSED SYSTEM: Septic Tank /06
P gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench 5 0 feet/Total system length zoo feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used #. /Depth or Thickness feet
*****************************
HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal .
*Alarms 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:
l
SIGNATURE OF RESPONSIBLE PERSON: DATE: 8/2oAd
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Leptic 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
S.) size and dimensions of all tanks, distribution boxes,
tile fields and/or drywalls
•
B. Nu 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 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
construccion.
•
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
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Remarks:
•
_locun ot QueenJtury :, 4./e..,
BUILDING and ZONING DEPARTMENT
Bay .nd Haviland Road, R.D. 1 Box 98 /947
IPueensbury, New York 12801
SEPTIC DISPOSAL SYST ; INSPECTION
NAME '
LOCAT I O '.,if ',If , ! r 7 i )1' ,__,Z? �'
DATE 42 ' / PERMIT N•. k 7
SOIL TYPE_J - and -��, 1 Clay -
Percolation Test Required? YES - NO
Percolation r to - Min/Inch - '
TYPE of SYST
Absorption field, tot,:l length p .
Length of each\trenc "* Zo ,
Depth of trenches: ' - p'L '° '
Size of graver '
SEEPAGE PITS{Number ;of)
Size- ft. X kL ft. .
Gravel size ,
PIPING: ' Size] Type
Bldg. to tank \ e7}( '
Tank to dist. box `-f" ,2YE.,
Dist. box to fiel•/pi " ,),
Openings sealed? VE NO Partial
LOCATION/SEPARAT ONS:
Foundation to t. k 0>c ft.
Foundation to acsor' tion d-O ft.
Absorption to 1.t Ike 'e�,�ft.
Separation of .its ft.
LOCATION' OF SY•.TEM 0 PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS: r
il // / 044144144, E
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SYSTEM USE APPROVED
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Building Ins ector
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