1990-702 . F �i ti ,
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date. November 11, 19 90
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This is to certify that work requested to be done as shown by Permit No.
has been completed.
This structure may be occupied as a
septic system
157 Luzerne Rd-Lots 26&27
Location
Owner NORTHWINDS MOBILE HOME PARK
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No. 90-702
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to
NORTHWINDS
OWNER of property located at Luzerne Rd-Lots 26&27 Street, Road or Ave.
in the Town of Queensbury,To Construct or place a septic system
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. =o
1. OWNER'S Address is =
Daniel & George Drellos
PO Box 224
Glens Falls NY 12801 1-1
2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
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5. ARCHITECT'S Addresssao
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( 1
7. PLANS and Specifications
Septic system as per plot plan and previously approved plans
No. Cn
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8. Proposed Use
Septic system cn
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 11 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.)
Dated at the Town of Queensbury this 11th Day of October 19 90
SIGNED BY / for the Town of Queensbury
Building and Zoning Inspe r
/,��;,� LI TOWN OF QUEEN BU Y 3-
��it j �i,'. APPLICATIOII FOR SEPTIC DISPOSAL PERMIT
:OWN OF Cale'`""fs-'szi.S Y
DATE: J o_ 9 Q- go E(;E I'
LOCATION OF PROPERTY FOR INSTALLATION '0I 1 `(A/,xa f / 0//Q 1gram '
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Owner' s Name:�DA//-e_ L f 6j -0�q� ���/�; „LDCo
Address: O ®k, �.2- iy / 6'
Installer' s Name: /fr / i ,/ w-� Telephone: 794.2- 2.7,f'-7
Number of bedrooms (residential only) /V ,4
Total daily flow (compute @ 150 gal per bedroom) 4A-
Topography: Circle one: OP 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: require required •
Rate - Min. Per Inch
Domestic water supply: Circle one: unici Well Other
If domestic water supply is a• wel :
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank /000 gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of /Size each C feet
by 8 feet
Size of stone to be used #. c:? /Depth or Thickness feet
*****************************
P M (1
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: DATE: / 0 ' 2 ?,:)
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 lot 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. 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 say
resulc 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
bu submitted to the Queensbury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
Riamarks: :,
®wn Of çu ee n 3 ur y
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98 /I)
Queensbury, New York 12801 //
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME & u~ J
LOCATION (4 f(p)1 a?
DATE /OJ/( / 96 PERMIT NO. 90-7Qa{
•
SOIL TYPE San Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM: ' r'
Absorption field, total length
Length of each trench !,
Depth of trenches ' I '
Size of gravel_ I 7
SEEPAGE PITS{Number of) '
Size- Cft. X �' ft.
Gravel size
PIPING: Size I' Type
Bldg. to tank
Tank to dist. box 4/'T 4 /pV'C
Dist. box to fiel. . 't Sp// /
Openings sealed? NO [ Partial
LOCATION/SEPARATIONS:
Foundation to tank 7., ft.
Foundation to abscrption 11.ft.
Absorption to lot line / Ift.
Separation of pits / ft.
LOCATION OF SYSTEM ON PROPERTX(circle one)
Front - Rear - Left side - Right side -
COMMENTS:
/sue— � 1
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>YSTEM USE APPROVED E
Bu nspector
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