1992-005 d.
CERTIFICATE OF COMPLIANCE
TOWN OF QU'EENSBURY
WARREN COUNTY, NEW YORK
Date January 24 , 19 12
This is to certify that work requested to be done as shown by Permit No. 92"iH15
has been completed.
This structure may be occupied as a Septic Alteration
L.acation 30 Yhippoorwi 17 Road
Owner Anthony Rossel l i
By Order Town Board
'i'OW'N OF QQUEENSB[ RY
r
Director of Bldg. do Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY X No. 92_oD5
WARREN COUNTY, NEW YORK IV
co
PERMISSION is hereby granted to Anthony Rossel l i •1
OWNER of property located at 30 Whippoorwill Rd Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Septic Al terati on
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.
t. OWNER'S Address is ?C
Same
J
2. CONTRACTOR or SUi LDER'S Name
Condon ' s Septic & Drain Service
79"542
3. CONTRACTOR or BUILDER 'S Address
4. ARCHITECTS Name
11C
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09
5. ARCHITECT'S Address a
J
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B. TYPE of Construction — (Please indicate by X)
f 1 Wood Frame ( ) Masonry ( 1 Steel ( 3
7. PLANS and Specifications y
No_ Septic Alteration to include: 2 seepage pits each 8 ' x8 ' using
#3 stone , 2 ' Thickness as per plot plan specifications and application
8. Proposed Use .�..
Septic Alteration
C«
0
$ 25_ 00 PERMIT FEE PAID — THIS PERMIT EXPIRES January. 19�_
(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 Oueensbury this Da January 19 Q2
J
SIGNED BY ' - for the Town of Queensbury
building and rf9 1 r pector
'R� 5 C) F
TQ TOW� YCO
APPLICATION FOR SE SAL PERMIT Permit # �0�
Fee Paid C�1j
JAR Q 21992
Date : `/ Reviewed B
C:C3DE DE1'T,
LOCATION OF PROPERTY FOR INSTALLATION :
Owner ' s dame : 141t' fZlU p, rf
Owner ' s Mailing Address ?o
InstalTer ' s Name : Cj LJ� � F� v . { '� 'rrf� rn- --S Phone # :
Number of bedrooms ( if residential ) :Y
Total daily flow ( residential - compute @ 150 .gal . per bedroom ) :
Topography- Circle One : FT 1.at 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 ? / 'Jed Feet
Percolation Test-Circle One • ot Required Required/ Rate Min . Per Inch
QN._ _ _ - --
Domestic Water Supply- Circle One : Cunicipal Well Other
If domestic water supply is a well ----
Separation : Water supply from any septic absorption feet
PROPOSED SYSTEM. Septic Tanis /ee) gal . ( Minimum size : 1 , 000 gal . )
Tile Field : Each Trench feet//Total System Length feet
Seepage Pit ( s ) : Number of J Size each : ' ft , x ft .
Size of Stone to be used : # s / Depth or Thickness e' 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 : +� e �f /a" ' , :"�. _ :'r DATE : ` r "
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 ��a����____n_�y water supply
5 ) size and dimensions of alTtanks , distribution boxes , the fields
and/or drywelIs
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 in 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 :
_._ tvn v Q"een36urt�
BUILDING and ZONING DEPARTMENT
Say and Hauitand Road, R.D. 1 Box 98
OUeensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME `� 1
LOCATION - -yam
,! I / PEiT NO .
/�-
! 7 ao f
RM
DATE
Loam - clay -
SOIL TYPE ~ - NO
Percolation st Required? YES
Percolation rate - Min/Inch
TYPE of SYSTEMS t tal length
Absorption f i+eld .
Length of each tren h
Depth of trenches
Size of gravel
SEEPAGE PITS <er
Size- C7 f t. X
427
Gra I
v e e l siz ze Type
PIPING :
Bldg , to tank
Tank to disc . box
Dist. box to fie / NO Partialppeninr}s sealed
LOCATION/sEp TI
Foundation a
tank r_ _ €t.
Foundation to absorption ft.
Absorption to lot line
£t ,
Separation of pits [ 13 PROPER (circle one)
LOCATION OF SYSTEM - Right side -
Front ~ ea - Left side
CC7MMENTS : h`
SYSTEM USE APPROVED ES NO
Bui ing Inspector
01/86 and vl
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