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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
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WARREN 'COUNTY, NEW YORK , . .
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Date December 17 • 19 90
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This is to certify that work requested to be done as shown by Permit .No. 90-814
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has been completed. . .
This structure may be occupied as a Sewage alteration
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1.nration, '-::-50'Ilincrest
,.. ,Owrker ' . Jan Laakso
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By•Order Town Board
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TOWN OF QUEENSBURY
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Director-of Bldg. & Code Enforcement ''s4:‘ .,
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BUILDING PERMIT
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TOWN OF QUEENSBURY
No. 90-814
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Jan Laakso °i
OWNER of property located at 50 Wincrest 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 Same
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2. CONTRACTOR or BUILDER'S Name Queensbury Sewer
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
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( )Wood Frame ( 1 Masonry ( )Steel ( ) _ _ ` CD
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7. PLANS and Specifications 1 a
No. Sewage alteration as per plot plan specifications and application a
including: 1000 gal tank, 2 seepage pits each 6'x 8' #3 Stone, 2' Thickness
8. Proposed Use
Sewage alteration
$ 25.00 PERMIT.FEE PAID —THIS PERMIT EXPIRES December 4 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 ,--4-t-h Day of , December 4, 19 90
SIGNED BY U for the Town of Queensbury
Building and ZonirWI nspector
/ _ TOWN OF QUEENS R
`f#tj 6 4— �--/l APPLICATION FOR SEPTIC D P IT
DATE: <,c :g - q Q
LOCATION OF PROPERTY FOR INSTALLATION Z-73 St) -1-i /U --2j
Owner' s Name:
( )- d-e--it,kcc 6 •
Address: , 1110 crc,s(
Installer' s Name: ak,p ,Afc Jc,e- - Telephone: 7r-c>236‘VI
Number of bedrooms (residential only) ,3
Total daily flow (compute @ 150 gal per bedroom) /
7160
Topography: Circle one: Flat Rollin! Steep Slope % of Slope
Soil Nature: Circle one: an 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, well :
Separation: Water supply from any septic absorption feet.
- PROPOSED SYSTEM: Septic Tank /�b-s--0 gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAG C PIT(S3) Number of 2_ /Size each (,, feet
by feet
Size of stone to be used #'. 1 /Depth or Thickness )- /. feet
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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: ,, ,o -` DATE: 4,e �-- ??,/
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 systea
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. Nu system shall be covered before inspection and approval by the
Building Inspuctor. 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—
tion, alteration or repair of an approved system, a new proposal must
bu submitted to the Quigunsbury Building Department before further
c oils t ruc c ion.
Town of Quesnsbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
• Queensbury, New York 12804
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.Touin o/ Quen ,i4ur /1;o
BUILDING and ZONING DEPARTMENT,
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC ,DISPOSAL SYSTEM INSPECTION
NAME . icZ Aa21 Sep
LOCATION i 2 e:641 c/2-e s7 L
DATE / /a / 90 PERMIT NO. 94-1
SOIL TYPE - 0 p Loam - Clay -
Percolation Test Required? - YES - NO
Percolation rate =; Min/Inch
TYPE of SYSTEM: I
Absorption field, total length
Length of each trench' _
Depth of trenches �4, - •
Size of gravel /
SEEPAGE PITS4Number 'aof) 2 /
Size- ft. X 5 'ft. 54;r--�/
Gravel. size • . '(;4 /
PIPING: ? Size Type
Bldg. to tank ` 4 f;-i '
Tank to dist. box / /e
Dist. box to field/pits. it / //
Openings sealed? YESt NO !Partial
LOCATION/SEPARATIONS.
Foundation to tank
Foundation to absorptions ft.
.Absorption to lot line /c> ft.
Separation of pits ft.
•N OF SYSTEM ON PROPERTY(circle one)
Fron - Rear - Left sider Right side -
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SYSTEM USE APPROVED O
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Bu g sp ctor
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