1991-001 •
CERTIFI ATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK •
Date aannAry P 19 Q1
•\
d'L)
This is to certify that work requested to be done as shown by Permit No. qi-nni
has been completed.
This structure may b .occupied as a Sewa op al tP ra ti nn
Location *Manor Drive a14J vnem of -be •
Owner IliipAnchliry Armc
By Order Town Board
, .
TOWN OF QUEENSBURY
.Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No 91-00i
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Queensbury Arms
OWNER of property located at One Manor Drive
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
2. CONTRACTOR or BUILDER'S Name
R.E. Roberts
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( 1 Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. Sewage alteration as per plot plan specification and application
including: 2 seepage pits to be restoned with #3 Stone and New Dist. Box & Pip- ng
8. Proposed Use
Sewage alteration
$ 25.00 PERMIT.FEE PAID —THIS PERMIT EXPIRES January 2, 19 93
(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 „2nd-, Day of January 19 90
� 9
SIGNED BY �/ ))/2At ' i for the Town of Queensbury
Building and Zoning Insdector
TOWN OF QUEE RY
•
011421 APPLICATION FOR SEPTIC DISPO ERMz.� ,,r �, �-P,nn
+v« N�L�w URi r
R EC,EhI .L)
DATE: TA A/ ) /9q 6 JAN 2 1991
LOCATION OF PROPERTY FOR INSTALLATION /44.1V6 ? Di?
A [3LDG. & CODE DEFT.
Owner' s Name: ��1=1�/5 5�h y R
Address: 1 ,AA-4"m7 D fi ou5 A/4 6Cf y ivy, o'Y
Installer' s Name: I( , I^, if C) IE/ ( 5 Telephone: (;: 4'' 249'
Number of bedrooms (residential only) O
Total daily flow (compute @ 150 gal per bedroom) G C -
Topography: Circle one: 4411, 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, well :
Separation: Water supply from any septic absorption feet.
&STU/Cod size: 1,000 alPROPOSED SYSTEM: c ank Q ad - gal . (minimumgal )
TILE FIELD• Each Trench feet/Totaj item length feet
kS /t1!®
SEEPAGE 4 PIT Number /Size each 5 feet
by _fee 4 t-SNVIOL--13
Si r 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: (7b/u K (/( 47 DATE: / Q 5)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 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 ranks, distribution boxes,
tile fields and/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 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 inscalla—
cion, alteration or repair of an approved system, a new proposal muse
be submitted to the Queensbury Building Department before further
construction. •
'Town of Queensbury
BUILDING and CODES DEPARTMENT
-Bay and Haviland Roads
Queensbury, New York 12804
kaniarks:
_/own of Queeniiur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME pZ412€4464/) 1444"
LOCATION 1114 10-
DATE ")/7 / q/ PERMIT NO. 9 1_61 0
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch _
TYPE of SYSTEM:
Absorption field, total length
Length of 'each trench /
Depth of trenches '
Size of gravel_
SEEPAGE PITS{Number of);!_
Size- ft. `X ft,
Gravel size \, ,
PIPING: Size Type
Bldg. to tank
Tank to dist. box
Dist. box to field/pit
Openings sealed? \YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank r''+ . ft. •
Foundation to absorpti�„'� on ft.
Absorption to lot ,.'line ft.
Separation of pits \ ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side, - Right side -
COMMENTS:
P
6(21-ca )1‘t).' „tlii' id:3 5:-.'flot.e
a fJ4l/s k .
}
•
SYSTEM USE APPROVEr.� NO
•.: / A
B 47 ding I .pector
01/86 and vl
. Jocvn o/ Queenitury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
•
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME CP)62EYYX.51,--)Okr- vr•� m c
LOCATION Oi e 1 ' N r .Q---
DATE 1 / 3 PERMIT NO;. — no/
SOIL TYPE - Sand - Loam t' Clay - ,
Percolation Test Required? YES - NO ,
Percolation rate - Min/Inch
TYPE of SYSTEM: , 1
Absorption field, total length
Length of each trench y`
Depth of trenches {' f"f
Size of gravel ,'
I
SEEPAGE PITS{Number of) ;;i • 4r
Size- ft. X ft. I
•
Gravel size ,
PIPING: Size /Y Type
Bldg. to tank ,1 / •
Tank to dist. box s'
Dist. box to field/pit ;,eb
Openings sealed? YES '��. NO Partial
LOCATION/SEPARATIONS• •1 ,
Foundation to tank ft.
Foundation to absorption ft.
Absorption to lot line ?':, ft.
Separation of pits/ 4 ft.
LOCATION OF SYSTEM' ON PROPERTY(circle one)
Front - Rear - Left side• - Right side -
COMMENTS: / i`
0 C.t 44,074,)/05: 7 . . A'')
•
SYSTEM USE APPROVED YES NO
I,.: / r
Building In pector
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