1991-016 t _•
CERTIFICATE OF COMPLIANCE
TOWN N OF QUEENSBURY
WARREN COUNTY,:NEW YORK
Date January 21 a 19 91
This is to certify that work requested to be done as shown by Permit No. 91-016
has been completed.
This structure may be occupied as a Sewage System
Location Luzerne Rd Lots 52 & 53
Owner Northwinds Mobile Park Daniel & Georae Deel l os
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING%-,
--I
r PERMIT X
TOWN OF QUEENSBURY
No. 91-016 0
WARREN COUNTY, NEW YORK
N
PERMISSION is hereby granted to Northwinds Mobile Park Daniel & George Drel l os
OWNER of property located at Luzerne Rd Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Sews gP 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. 0
Z
1. OWNER'S Address is
PO Box 224
Glens Falls, NY
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2. CONTRACTOR or BUILDER'S Name tT
J•
Sanitary Sewer m
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3. CONTRACTOR or BUILDER'S Address
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0
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4. ARCHITECT'S Name N
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ts1
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) 0-
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No_ Sewage System as per plot plan specfications and application
to include: 1000 gal septic tank, 2 seepage pits each 6' x 8' #3 size stone r+
8. Proposed Use
2' Thickness
Sewage System
$ 25.00 PERMITFEE PAID —THIS PERMIT EXPIRES January 15, 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 15th Day of January 19 91
SIGNED BY for the Town of Queensbury
Building a d Zoning Inspector
%Zeit. of Queez34 .iWN OF QUEENS U r
RECEIVED
APPLICATION FOR SEPTIC DISPOSAL PERMIT JAN 15 1991
rm.DC. & CODE DEPT.
DATE I / 91
LOCATION OF PROPERTY FOR INSTALLATION iD&fik Pock;i
Owner's Name: M )154.- ,Cid. I ///4' Telephone: 79 -726 '7
Address: l AO Si.. Gf
Installer's Name: St/ y , /.W' Telephone: 7c9 -72,5--7
Number of bedrooms (residential only) I 1
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one: Flat. Rolling Steep Slope % of slope
Soil Nature: circle one: Sand Loam Clay Other / Depth: feet
Ground Water: At what depth? feet
Bedrock or Impervious Material: At what depth? _ feet
Percolation test: circle one: not required required / rate min. inch.
Domestic water supply: circle one: Municipal Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM: Septic Tank 1 O T.1O gal. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S): Number of / Size each 4 feet by (S). feet
Size of stone to be used # / Depth or Thickness 2 feet
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
IMPORTANT
...Please...LIST NEW EQUIPMENT TO BE INSTALLED
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
crag 6 rr?D p 1--/1->"J
(over)
Section II 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 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 to any water supply
5.) size and dimensions of all tanks, distribution
boxes, tile fields and/or drywells
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 to produce said plot plan at time of inspection may result
in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
I have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbury Sanit-a ewage Disposal Ordinance.
Signature of responsible person: 6044.
Date: _ I— �� �� 1/! - - -` - -- ---- -
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD,PLACE TO LIVE
// OJC��c'��
• Jouin ot Queenibury
BUILDING and ZONING DEPARTMENT / iiiJ
Bay and Haviland Road, R.D. 1 Box 98
' Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
r
NAME (M- ( 4,u d a)
LOCATION ,a'- ,1/5-7 d 53)
DATE IJ 17 /q1 PERMIT NO. G?/ -Q 1 ,
SOIL TYPE fan- Loam - >lay -
Percolation Tes Required,• YES - NO
Percolation rate -',Min/Inch
TYPE of SYSTEM:
Absorption field, totalJlength
Length of each trench l
Depth of trenches •
Size of gravel i y
SEEPAGE PITS4Numbe of) •
Size- 7ft. X ;ft.
Gravel size . — 3
PIPING: 0 Size Type
Bldg. to tank l�
Tank to dist. box '!� — h/C
Dist. box to fielp/pit / " p(/QJ
Openings sealed? ! YES NO Partial
LOCATION/SEPARAT'IONSE
Foundation to tank 1 ft.
Foundation to ,absorption ft.
Absorption to./lot line a.EJ ft. •
Separation 4/pits I 35 ft.
LOCATION SYSTEM ON PROPERTY(circle one)
Front Rear Left side - Right side -
COMMENTS:
•
SYSTEM USE APPROVED CP NO
41/2-;-
Build ng In pe tor
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