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1992-010 CERTIFICATE 'ICATE CJ� COMPLIANCE -r©WN oIF QUEENSBURY i WARREN COUNTY , NEW Y4R date January 169 19 f hey //�� `�..., 7L'^V� �k This is to certify that work requested to be ,clone as rhowr► by Permit No. has been completed. Septic Alteration This structure may be OCC,,p,ed as a t ct Street } Xp prospe l Z„ocariors owner �6ary L.eBarron gy order Town Board -TOWN OF QUF'ENSBURY 1 Director of Bldg- do Cade Enforcement } 1l BUILDING PERMIT TOWN OF QUEENSBURY No. 92-010 WARREN COUNTY, NEW YORK w Lebanon ' PERMISSION is hereby granted to >r` Street, Road or Ave. �..� OWNER of property located at � t Street p tY in the Town of Queensbury, To Construct or place a -SeD tion at the above location in accordance to application together with plot plans and other information hereto filed a nd Ordinance- approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. 1. OWNER'S Address is 2 SA1ne a� sv 2_ CONTRACTOR or BUILDER'S Name �c Queensbury Sewer 3, CONTRACTOR or BUI III IS Address H+ C 'd N'! 4, ARCHITECT'S Name r"f rr tart e-r 5. ARCHITECT'S Address A moo tars 6. TYPE of Construction — (please indicate by X) W n I i Wood Frame I I Masonry 11 Steel I I W rD �R 7, PLANS and Specifications � Septic Alteration to include - No. 1ppp al Tank with 130 ' of tile lIfiel specifications and app onsing #2 stone , 1©" Thickness _ as per p of plan 8, Proposed Use Septic Alteration January $ 25_ 00 peRmIT pEE PAID — THIS PERMIT EXPIRES m ectar of the Itf a longer period is required an application for an extensi spon must Ure made to the Building and Zoning ' town of p n ueesbu ry before the expiration date.! i3th Day of January -19--�..- Dated at the Town of Queensbury fS for the Town of Queen sbury SIGNED BY _ Building a Zonirg 1nsfta''cl'ar ,.. TOWN OF QUEEN:i504-i r TOWN OF Q �Q��"/ rmi t # APPLICATION FOR SEPTIC DI i311;�J Paid ,3AM U 91991 ``�� ,�,7 DWf ewed By D a to : fLD1NQ �► G4fl� LOCATION OF PROP£ Y FOR IN �' owner ' s Name , Owner ' s Mailing Address : eT Phone Installer ' s Name : 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 : San Loam clay Other /Depth : Ground Water-At What Depth ? Feet Bedrock or Impervious Material -At What Depth ? Feet Percolation Test Circle One :(:,:!of Req, re� Required/Rate Min . Per Inch Domestic Water Supply- Circle One : ,-1" nlciPa Well Other If domestic water supply is a well feet Separation : Water supply from ate!'. septic absorption PROPOSED SYSTEM: Septic Tank o�dr� gal . ( Minimum size : I , 000 gal . ) �'' Tile Field : Each Trench 4feet//Total System Length ZCJ feet Size each : ft . x ft . Seepage Pit ( s ) : Number of / Size of Stone to be used : Depth or Thickness lam' feet HOLDING TANK SYSTEM IF REQUIRED Gal , Na . of Tanks Size� of Each Alarms system and associated electrical work to be inspected by a certified agency **f kirit�r** yrilrytir�r k 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 . DATE : SIGNATURE OF RESPQIIsISLE PERSON : j a . i fir . ltSe�tic_`' `yStem Inspections : A . All applications for 9`eotWo ' 4N em installation , alteration or repair , as required by the Town of Queensbury Sanitary Sewage Ordinance , small 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 70t lines 3 ) location and distance to structures 4 ) location and distance to any water supply 5 ) size and dimensions of all tanks , distribution boxes , file fields and/or drywells Be 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 & Cade Enforcement Department 531 Bay Road Queensbury NY 12804 Remarks : ueel736ur� 90w" D N1fyG EPA Nj4.TtAF f BUILDING and Zo R•D t BOY. 98 BOA Bay and V48"ancl Read i2 - C]veensbury. New York SEPTIC 015POSAL SYSTi � }t1SP'EC� 1 O1`1 LOCAT 1CA`1 DATE — _ Clay 130 S d YES TYI' an a heal? percolation eae 14in/Inch percolation ra"� of gY STFt+!: total TYg ;a,bsOrPt o each trench �� -�-- i e gt:h Of of trenc es Si.ze of gravel er sss-PP.GE �,ITS•#T3 ft. �- ft- X - Type Size- Sire - - Gravel syze -- plp2i3Gto tan T31 g - di s - 7bc� TanK to d/FxtO Partial Dist ' Z�X ealed7 OP en ing IAC t ]c am`1 ft at . ion to you absorption ,� o f t. Eoundatiorn to lojc line �ft- one3 A]�soxPtion to `�- (circle of S'Pits� 014 PI Og' ht side EEi`X srm gefaxatioxsRig bpC TY. ear Jeft side Front CCMNI'ENT 5 1� YES SY S`Y U SF FsPvptov uil nc3 In pectar Ol/ $�' mc1 v1 ` �vwn v� pP1to3G QSpARTM�f1 and Z 1 50% g8 D1 c1. R. 12601 Bay and vtavlland 'Boa ,lork Queerisbury , ►'aew iNSPECYIOr1 L SY STR� SEPTIC C7ISP05P `�j �� •C t, Y /~''1 LOCATIC9N j NO ,� - `yr' P �1'I1' clay Sand a�xed7 yE5 SOWS tion P e�cola r P er cola'C.ion �_ Q of SY5 �ota3. ],.e AbSOT- � on field th Of each ncl� Depth of trench 5ize of c3xavee off If ve] ze ' Size •�YPe G:Ca to tanK �_� r-- - -19 131Clist - d/ O pa-~� zti al t0 bOYL to s L1 iSt- s seal � C)Penin� AFA`S'IC7I� JPt. SAOA.rJoI4 to tangy fit �•,otyi3c'1at - U 10t lie qne) $'O' t j,C5n to �'ft- cle p,YygorP of Pt iS PRO-PFP.TY [o Jr de POp.T2 SYS�, d _ Right si Si e CFF _ gear r ;srrs �O ray S'S'� i3 SE APPRC�]''�D InsP ctor 0.1 and vl �ourre v� �t�,een3hi,ere� BUILDING and ZONING DEPARTMENT Bay and Haviiand Road, R.0- 1 Box 98 aueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAMEo LOCATION �/`^' 0—/4Z2:- " 7 DATE PERMIT NO . SOIL TYPE - Sand - Loam - Clay - Percolation Test Re iced? YES - NO Percolation rate - in/Inc TYPE of SYSTEM: Absorption field , t tal ength Length of each tren Depth of trenches Size of gravel SEEPAGE PITS{Numbe f) Size- ft. X t. Gravel size PIPING : Size Type Bldgo to tank d . Tank to dist box Dist. box field/p Lt Openings algid? Y 3S NO Partial LOCATI /SEPARATIONS Foun Lion to tank ft- Foundation to absor, ion ft . Absorption to lot line ft. separation of pits ft. LOCATION OF SYSTEM ON PROPERTY (circle one Front - Rear - Left side - Right side - CCiMMEt3TS cv��'x /62 lA��e�ol SYSTEM USE APPROVE4YES NO Btor 01/86 rnd vl 1 L i i E I � I I I 1 ' t f 1111 � d0 NMpl 4 i 1� s��