1991-567 a - _
CERTIFICATE OF :-COMPLIANCE
-TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date ,�G.(I/0'X,ita /1 19 9/
This is to certify that work requested to be done as shown by Permit No. 91®567
has been completed.
This structure may be occupied as a Septic Alteration
Location Rotate 9 _
Dave White Ef terpr°i ses
Owner
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg.& Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBURY No 91-567
cn
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Log Jam Restaurant
OWNER of property located at Rte 9 Street, Road or Ave. r
ca
in the Town of Queensbury,To Construct or place a Septic Alteration c.,
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.
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1. OWNER'S Address is e+
Dave White - Dave White Enterprises
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2. CONTRACTOR or BUILDER'S Name
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)
( )Wood Frame ( ) Masonry ( I Steel ( )
7. PLANS and Specifications
No. Septic Alteration to include: 18 Seepage Pits each 10' x 8'
using #3 Stone, 2' Thickness as per plot plan specifications and application
8. Proposed Use
Septic Alteration
$ 35.00 PERMIT FEE PAID —THIS PERMIT EXPIRES AUGUST 14, 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 __loth Day of / /"., August 19 91
SIGNED BY /G,.{ - - for the Town of Queensbury
Building and Zoning Iriector
OWN OF LEEFNSBUI-i
�, RECEIVED
�� C TOWN OF QUEENSBURY -
APPLICATION FOR SEPTIC DI�WAL8P�§§i�T Permit # �/J0'
Fee Paid/L5
Q BLDG. & CODE DEPT.
Date: �✓ .) - t p / Reviewed By
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LOCATION OF. PROPERTY FOR INSTALLATION: �� a JcY.4v� kgXAWLY
Owner' s Name: 3i -V`L LJ671'/-E .^ �i9VE LuttrlitA e'iv ?`elkflrfu &S
Owner' s Mailing Address: 96 ��gyy1 IQESTUI H/�
Installer s Name: C M 6` .SF -�cc� f kAt u Phone #: 79f— & /
� `bp�ru s t
Number of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 gal . per bedroom) :
Topography-Circle One: Flat 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
(agea G,gy'septic, ��isflIU9 .
PROPOSED SYSTEM: Septic Tank gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s): Number of f$R / Size each: /0 ft. x ft.
Size of Stone to be used: # !J / Depth or Thickness 2 feet
**************
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks Size of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
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: 4:69 C t(jir`_ DATE: 53 8 2V
i,4.
•
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.
Town of Queensbury
Building & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks:
4y TOWN OF QUEENSBURY
Bay at Haviland Road, Queensbury, NY 12804-9725-518-792-5832
Building & Codes Department
INSPECTOR'S REPORT
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PROPERTY LOCATION\
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BUILDING SEWAGE ;(\ SIGN OTHER
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TOWN OF QUEENSBURY Bay at Haviland Road, Queensbury,NY 12804-9725-518-792-5832
Building & Codes Department
INSPECTOR'S REPORT
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Bay at Haviland Road, Queensbury, NY 12804-9725-518-792-5832
Building & Codes Department
INSPECTOR'S REPORT�t
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BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
19
SEPTIC DISPOSAL SYSTEM INSPECTIONAr
NAME Z (') C� n, 99
LOCATION � j —
DATE R/Zi ?( PERMIT NO. 7,
c— (�
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 ,J
Size of gravel Y f
SEEPAGE PITS{Number of) If
Size- ft. X _ ft. /
Gravel size • I •
'u
PIPING: is Size .,' Type
Bldg. to tank
Tank to dist. box
Dist. box to field/pit I.
Openings sealed? YES ;' NO Partial
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LOCATION/SEPARATIONS:`
Foundation to tank., ft.
' Foundation to abs7rlition ft.
. Absorption to'lost lihe ft.
Separation -of pi:ts ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear )- Left side - Right side -
COMMENTS:r'>
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SYSTEM—ttaE
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Building nsp" ctor
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Own~O f Queen�bury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road,'R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION '
NAME WO 9914„7// 4C2 a--) -
LOCATION 9
DATE ffr�ii/9/ PERMIT NO. %/— 5' ' `J
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{Nuinber of) ' '
Size- ft. ) ft. I
Gravel size
PIPING: Side Type
Bldg. to tank
Tank to dist. box , e'
Dist. box to field%pit J
Openings sealed? `YES/ NO Partial
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LOCATION/SEPARATIONS%
Foundation to tankf% ft.
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Foundation to absorption _ ft.
Absorption to lot lineft.
Separation of pit" ft.
LOCATION OF SYSTEM ON P� OPERTY(circle one)
Front - Rear - Left sid - Right side -
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SYSTEM USE APPROVED Y NO
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TOWN OF QUEENSBURY
Bay at Havitand Road, Queensbury, NY 12804-9725-518-792-5832
Building & Codes Department
INSPECTOR'S REPORT
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OWNER OR TENANT
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�_ _�' Bay at Haviland Road, Queensbury, NY 12804-9725-518-792-5832
Building & Codes Department
INSPECTOR'S REPORT
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PROPERTY LOCATION
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"HOME OF NATURAL BEAUTY.. .A GOOD PLACE TO LIVE"
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BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME s (f /1/j/,� ieWa, (../4
LOCATION o .j
DATE Of/ ,l 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 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 ft.
Foundation to absorption ft.
Absorption to lot line ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS:
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Bay at Haviland Road, Queensbury, NY 12804-9725-518-792-5832
Building & Codes Department
INSPECTOR'S REPORT
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PROPERTY LOCATION
OWNER OR TENANT
BUILDING SEWAGE SIGN OTHER
REMARKS'
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TO NYS. ROUTE 9
FROM EXIST KITCHEN INKS
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5F-WAGf-.APPLICATIO ' RA
N RATE "
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1.2�6PQ/FT
INV. 527 FT
1
L ENGT q OF Ai3 SORPTION FIELD .
trtR�M
GREASE
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DOSING TANK 350 GAL./DOSE-
1560 LIN.F7;
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CENTER ( EI SED ON 40 EMPLOYEES)
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LENGTH OF ABSORPTIONT FIELD:
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2 0
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FOR PEF�,COLATION T RE a - ..
TE5 RESULTS SEE WG. A 44-4
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