1990-755 CERTIFICATE 'OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19 -
fajq
This is to certify that work requested to be done as shown by Permit No. 90 755
has been completed.
This structure may be occupied as a septic system
( ( C( Bay Road
Location /
Grey Hunter
Owner
By Order Town Board
TOWN OF QUEENSBURY
\ r
Director of Bldg. do Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 90-755
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to GREY HUNTER w
OWNER of property located at Bay Road Street, Road or Ave.
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
RD#5 Box 116,
Queensbury NY 12804
2. CONTRACTOR or BUILDER'S Name
Maille
co
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
w
5. ARCHITECT'S Address
0
w
a
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. Septic alteration to include septic tank only. (1000 gallon)
8. Proposed Use
N
rD
Septic system
$ 25.00 PERMIT.FEE PAID -THIS PERMIT EXPIRES October 31 19 92
-s
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the -rj.
town of Queensbury before the expiration date.) �•
0
Dated at the Town of Queensbury this 31st Day of October 19 . 90
SIGNED BY for the Town of Queensbury
Building and Z n ng Inspector
3_? TOWN OF QUEENSBURY
01i<j APPLICATION) FOR SEPTIC DISPOSAL PERMITlr-
/f
DATE:/ )3 a/ ? 6
LOCATION OF PROPERTY FOR INSTALLATION A rat/ --
Owner's Name: �y �e (147 �, ,J 1990
Address: (� A 6-v ii6
& CODE DEPT.
Installer' s Name: )3jralj),p, Telephone: 7 92 G 6 Q 7
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: Circle one: a Rolling Steep Slope % of Slope FG a�'k
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 We0 Other
If domestic water supply is a well :
Separation: Water supply from any septic absorption J y 6' feet.
PROPOSED SYSTEM: Septic Tank /6 00 gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used if. /Depth or Thickness feet
*****************************
HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal.
*Alarm system, and associated electrical Mork 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 PERSONS 777 DATE: /6/3 °/ T�
•
Septic System Inspections:
A. All applications for septic' syscem installation. alteration or repair.
as required by the Town .of Queensbury Sanitary Sewage Ordinance. shall
by 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 co any water supply
5.) size and dimensions of all tanks. distribution boxes.
rile fields anal/or drywalls
B. Nu system shall be covered before inspection and approval by the
uuilding Inspuctor. Failure to comply with this requirement may
result in the uncovering of tha 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 tine of inspection may
rusult 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 co the Queensbury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury. New York 12804
kv.marks:
-/own o f QueenJ‘ury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98 /J
Queensbury, New York 12801 ( (but-
pm
/
pm
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME fA1.�1.t /it''�C%)
LOCATION �/ ,?GiQ/
DATE A/ 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 tre ch
Depth of trenches ' •
Size of gravel
SEEPAGE PITS-(Number o )
Size- ft. X _ f
Gravel size . I
PIPING: Si e / Type
Bldg. to tank /i'1
Tank to dist. box
Dist. bo): to field/pit7"i P-e/C
Openings sealed? YES Partial
LOCATION/SEPARATIONS:
Foundation to tank !j 1t.
Foundation to abscrption f .
Absorption to lot line ft'I;�
Separation of pits ft.
LOCATION OF SYSTEM ON IROPERTY(circle one)
Front - Rear - Left si e - Right side -
CCMMENTS: / �\
/L
r`
SYSTEM USE APPROVED YES ' NO
ilding In ector
01/86 and vl
ph-4- -p7_7
/S-0Lc- -0
y �1�azZ
/
I
J
L M y
+� lb
y'
--�—� SG z /`e O C e `? 1990
1\1°—(--
e Dom. & CODE DEPT.