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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date November 26 19. 90
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,;This is to certify that work requested to be done`as shown by Permit No. 90-673
has been completed.
This structure may be occupied as a septic system
i
Location 9 Oakwood Drive
Mrs. William Lake
Owner
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY, x
No.
90-673
WARREN COUNTY, NEW YORK
-v
MRS. WILLIAM LAKE \ o
PERMISSION is hereby granted to
9 Oakwood Drive
OWNER of property located at Street, Roa�.,�Ave. C."
Sewage alteration
in the Town of Queensbury,To Construct or place a \ w
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
2. CONTRACTOR or BUILDER'S Name A
Queensbury Sewer
-s
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N
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
0)
0
0
6. TYPE of Construction—(Please indicate by X)
t7
( )Wood Frame ( ) Masonry ( )Steel ( ) 'S--•
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7. PLANS and Specifications
No. Sewage alteration to include two seepage pits 8'x8' with #3 stone at
two foot.
8. Proposed Use
Septic system.
to
CD
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 4 19 92
rD
(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 4th Day of October 19 90
SIGNED BY C'ty� \ for the Town of Queensbury
Building and Zoning Inspector
,` �a"` ;-jc _ 3 , TOWN OF QUEENSBURYWN ` QLF�ISBURY
6 j APPLICATION FOR SEPTIC DISPOSAL PERMIT H C�-�;1 D
DATE: 0C- - - ' ,— re OCT - 11990
LOCATION OF PROPERTY FOR INSTALLATION /yr7 0q466. O-A .'.• & CODE DEPT.
Owner's Name:
Address: q _ eo kj,cik_,
Installer' s Name: 694'eLiSct)U-1/' ' ek) Telephone: 79' cEC 5/s"
Number of bedrooms (residential only)
thrF:.
Total daily flow (compute @ 150 gal per bedroom)
Topography: Circle one: lat 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
Percolation test: Circle one: not required required
Rate - Min. Per Inch
Domestic water supply: Circle one: Municipal Well Other
If domestic water supply is a. wel :
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank /�—a--6 gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAG PIT(S): Number of .Z /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.
*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. 1 DATE: (9-7-1 �1- r 7-0
•
•
Lucie 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 leasc 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,
cile fields anal/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 construc.cion
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 inscalla—
tion, alteration or repair of an approved system. a new proposal must
be submit-tad to the Queensbury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
• Queensbury, New York 12804
•
Remarks: ,. •
Va1‘.1-11 ,, CCIrppU
Down ol Queensbury . /°0 PIA
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
•
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME rcm L)m. Jct.ke__
LOCATION 9 (?) ,1(.(,,,_)() ,(-)c cc V P
DATE 4 / /A)OPERMIT NO. ()/// 673
SOIL TYPE - and r Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM: ( ,/
Absorption field, total .length ,/
Length of each trench i' /
Depth of trenches t /
Size of gravel t /
SEEPAGE P ITS*Number of)P. qZ /
Size- ,Q ft. X $" ft.
Gravel size ,- - 9
PIPING: S-ize Type
Bldg. to tank 'q• f •
Tank to dist. box rr` '�t/�/ ,
f
Dist. box to field/pit / 1/
Openings sealed? YES NO Partial
LOCATION/SE?ARATIONS:
Foundation to tank 4,15,4 ft.
Foundation to absorption ;jG. ft.
Absorption to lot li e 6 ft.
Separation of pits a ft.
LOCATION.,OE-SSTEM 'ON ROPERTY(circle one)
Front <Rear Le si e - Right side -
COMMENTS:
0 ? .
, -rp
SYSTEM USE APPROVED YE / O
f/46h/J j 1
Building Inspector
01/86 and vl
,�' /� '
,V e7 //
�\ Jouin of Queen u r y
6 BU;LDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
•
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME ��%s/f- ���
LOCATION 9 4716w,1 6. /As
DATE/ 6 /Se) PERMIT NO.
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trer}ch
Depth of trenches .1
Size of gravel_
SEEPAGE PITS{Numbe of) •
Size- ft. X 1 ft.
Gravel size
PIPING: i; Size,' Type
Bldg. to tank
Tank to dist. box
Dist. box to field/pit
Openings sealed? YES! NO Partial
LOCATION/SEPARATIONS:/ ,
Foundation to tank ft.
Foundation to abscrption ft.
Absorption to lot /line ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side -\ Right side -
COMMENTS: i
•
SYSTEM USE APPROV .vO
Building Inspector
01/86 and vl
(
OWN OF (.7131:--:ENSSURRECE WED
OCT,- 1 1990
BLDG.. & CODE DEPT.
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