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//% CERTIFICATE OF COMPLIANCE ,
' TOWN OF QUEENSBURY
Y '`'
`c WARREN COUNTY, NEW YORK
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Date September 25 19 90
\ A___\ ____. .0i
This is to certify that work requested to be done as shown by Permit No. 9i1®6i35
..-
has been completed.
This structure may be occupied as a - septic system
26 Pershing Road
Location
JOSEPH GIACOBBE
Owner
By Order Town Board
TOWN OF QUEENSBURY
, .
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No 90-635
WARREN COUNTY, NEW YORK -c
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PERMISSION is hereby granted to JOSEPH GIACOBBE
26 Pershing Road Street, Road or Ave.
OWNER of property located at
sewage alteration
in the Town of Queensbury,To Construct or place a g
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
same
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2. CONTRACTOR or BUILDER'S Name ccc
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Sanitary Sewer
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3. CONTRACTOR or BUILDER'S Address CD
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4. ARCHITECT'S Name
5. ARCHITECT'S Address `
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6. TYPE of Construction—(Please indicate by X) -
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( )Wood Frame ( ) Masonry ( ) Steel ( ) a
7. PLANS and Specifications
No. Sewage alteration to include 192 feet of tile field with #2 stone
at 1 ft depth.
8. Proposed Use
Septic systemco
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES September 19 19 92 w
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
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town of Queensbury before the expiration date.) --5
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Dated at the Town of Queensbury this 9th Da of September 19 90 0
SIGNED BY for the Town of Queensbury
Building and ing Inspector
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/kkA� //re _ TOWN OF QUEENSBURY
o S 3 APPLICATIOr1 FOR SEPTIC DISPOSAL PERMIT
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DATE: 9-'/O - o
LOCATION OF PROPERTY FOR INSTALLATION dC=:, 17(2 1,-, /iuc f.
StN
Owner's Name: �fl c )(n. 61(A-(1,16hp -
Address: olc - R2 RSG\ /,u co (-.2 .
Installer' s Name: 0 ,uc' ? Telephone: 791
Number of bedrooms (residential only) a
Total daily flow (compute @ 150 gal per bedroom) 4150
Topography: Circle one: Flat Rolling Steep. Slope % of Slope
Soil Nature: Circle one: Sand Loam Clay Other /Depth:
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what depth? Feet
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Percolation test: Circle one: not required required .
Rate - Min. Per Inch
Domestic water supply: Circle one: Well Other
If domestic water supply is a.. welggil_gEiT>
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank Gc..i'T/.v( gal . (minimum size: 1,000 gal ) ,
TILE FIELD: Each Trench 32 feet/Total system length - `R„/ , feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used #. ,Z /Depth or Thickness / feet
*****************************
HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks : Size of Each Gal .
*Alarm system and associated electrical. �►iork 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: ATE: 91--/O' /(o
1
a'
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 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 drywalls _
B. No system shall be covered before inspection and approval by the
Building Inspector. Failure to comply with this requirement may
rosult 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
dice. Failure to produce said plot plan at tims• 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.
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Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
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Remarks:
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awn.
01 Quri
- BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Clueensbury, New York 12801 (7)
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SEPTIC' DISPOSAL SYSTEM INSPECTION
NAME 192/2 0: .C,e'. )
LOCATION a5'(v -e�1'.��S�I
DATE_ 017 /'1,9D PERMIT NO. „ : Al
/
SOIL TYPE -Sand - Loam -play -
Percolation;}Test Required?? YES - NO
Percolation. rate - Min/Inch -
F
3f
TYPE of SYSEM: A
Absorption fiield, tota]! length ,Q`
Length of ea h trench j ,4.g- )
Depth of trenches "L--13 r-�} '
Size of graved Q L_.•-
SEEPAGE PITS4Number of),_-- •
Size- ft. IX eft. - _ -.
Gravel size
PIPING: 1 Size ' Type •
d.'
Bldg. to tank '� I� f:--- ' , -
Tank to dist. box ,,� J IQVc--
Dist. box to fie'lel/ (Arc—
Openings sealed?7`V YES NO Partial
JLOCATION/SEPARATIONS:
Foundation to tank - rt.
Foundation to absorption �'-, ft.
Absorption to lot 'line la ft{-
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Separation of pits\.. . / t.
LOCATION OF SYSTEML;ON PROPERTY(circle one)
Front ear' -r Left\ side - Right side -
COMMENTS: (( �t
.6,(15-Efik1616-77._ 7739A/K.___ .
LA,Izeil 0/1-31>f
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3
30
-PfSTEMar8E APPROVED 'ES NO '
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Building nspector
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