1992-012 « .
s:
CERTIFICATE '"F COlMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date----- Ll [ 4' 19
rig
CtCt j � �
za is to Certify that ork requested to be done as shown by Permit No. 92-012
has been completed.
This structure may be occupied as a Septic Al terati on
Loc260n4 Martindale Read
Owner Jams Bombard
BY Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. do Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 92-012 �
WARREN COUNTY, NEW YORK ,a
t7
PERMISSION is hereby granted to James Bombard
t
OWNER of property located at Martindale Rd Street, Road or Ave. •�+
in the Town of Queensbury, To Construct or place a Septic Alteration N
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
Sallee
cc
2. CONTRACTOR or BUi LD£R S Name
Bob El l sworth
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3. CONTRACTOR or BUILDER 'S Address J
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4, ARCHITECT'S Name C+
W.
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5. ARCHITECT Address .Ti7
Ci
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6. TYPE of Consrtruction — (Please indicate by X)
1!
fY
( S Wood Frame l 1 Masonry { 3 Steel
P'F
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7. PLANS and Specifications
No. Septic alteration to include : 200 ' of the field using #2 Stone
V thickness as per plot plan specifications and application
8. Proposed Use �•
Septic alteration
$ _ 25_ 00 _ PERMIT FEE PAID — THIS PERMIT EXPIRES January 15, 19 94
(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 th _ D f January fg 92
y f
SIGNED BY for the Town of Queensbury
Building and Zo ng Inspector
TOWN OF QUEENSBURY f�1�
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
Fee Paid
Date : f /:r Pa
Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION : '' � , f �I ./ ,e / a
Owner ' s Name : " Jex.w!4r W, 4,6
Owner ' s Mailing Address : .
Installer ' s Name : /, ,��,fd,� Phone # :
Number of bedrooms ( if residential ) :
Total daily flow ( residential - compute @ 150 gal . per bedroom ) : y'.St.7
Topography- Circle One : Flat o? ? in Steep Slope % of Slope
Soil Nature- Circle Ord` JSand Loa Clay Other /Depth :
Ground Water-At What Depth ? /r,G Feet TOWN OF QUEENiatkwb•4- 4
Bedrock or Impervious Material -At What Depth ? Fee ,1
Percolation Test-Circle One ; Not Required Required/Rate '`f' " Min Q - P cUAN 15 Wi
Domestic Water Supply- Circle One : ether gpEpEPT.
If domestic water supply is a well—=�
Separation ; Water supply from any septic absorption / i<9 "'' feet
PROPOSED SYSTEM: Septic Tank too-o gal . ( Minimum size : 1 , 000 gal . )
Tile Field : Each Trench .5 4e1 feet//Total System Length w2 e~ra feet
Seepage Pi t ( s ) : Number of Size each : x f" ft .
Size of Stone to be used : # c+Z / Depth or Thickness 1 feet
HOLDING TANK SYSTEM IF REQUIRED
No . of Tanks Sizelof Each Gal .
Alarm system and associated electrical work to be inspected'Ty 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 : GATE :
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 al 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 do � d 4 le work stoppage .
IL
D ShoiAld : un *een problems during construction prevent proper installation ,
itUal teriiitiio "'repai r 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 :
060 QU BURY f o
BUILDING AND CODES DEPARTMENT �t m
531 BAY ROAD
QUEENSBURYa NEW YQRK12804
TELEPHONE ( 518 ) 792- 5832
BUILDING INSPECTOR' S REPORT
REQUEST FOR INSPE =RECEIVED
..1
NAME fy
LOCATION
DATE Ci PERMIT # `
TYPE OF TRUC URE
RECHECK APPROVED
QO IN / E N/A YES L.No
MONOLITHIC POUR RM
REINFORCEMENT IN PLA E
THE CONTRACTOR IS RESPON IB E
FOR PROVIDING PROTECTION FRO"
FREEZING FOR 48 HOURS FOLLOWING
THE PLACENM OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLAC
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENTJV N IN ACE
PLUMBING UNDER SLAB
FRAMING :
_,,... JACK STUD /HEADS S
BRACING/ BRIDGING
JOIST HANGERS
JACK POSTS /MAI BEAM
FIRESTOPPING
WALLS
CEILING
FIREWALLS
HEATING R UGH- IN
INSULATION:
FOUNDATION LLS IN E IOR R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R_
WALLS _
CEILINGR_
DUCT WORK QR IPI G N UN EA EO
SPACES
EMA KS :
ARRIVE
DEPART
INSPE TOR
TORN of QUEENSBURY '1
BUILDING AND CODES DEPARTMENT
531 BAY ROAD "T Ll'c: ti
QUEENSBURY , NEW YORK 12804 / lsrl
TELEPHONE ( 518) 792- 5832
BUILDING INSPECTOR ' S REPORT
REQUEST FOR INSPECTI^RECEIV -
NAME
LOCATION 1� ,
DATE PERMIT if
TYPE O STRUCTURE�
RECHECK APPROVED
N/A YES NO
OO NG / S
MONOLITHIC POUR FO
REINFORCEMENT IN PLACE
THE CONTRACTOR S RESPONS LE
FOR PROVID B CTION FROM
FREEZING HOURS FOLLOWING
THE PLACEI4E OF THE CONCRETE,
MATERIALS F THIS PURPOSE ON SITE
FOUNDATION A POUR
REINFORCE NT N PLACE
FOUNDATI /DAM OOFING
BACKFIL APPROV
ROUGH UMBING
PLUMB G VENTlVEN I E
PLUMB NG UNDER SLAB
FRAMING :
JACK STUDS/HEADERS
BRACING/BRIDGING
JOIST BANGERS
JACK POSTS /MAIN BEAM
FIRESTOPPING
WALLS
CEILING
FIREWALLS
HEATING R UGH- IN
INSULATION:
FOUNDATION WALLS N ERI R R-
FOUNDATION WALLS EXTERIOR R-
FLOORS R-
WA LLS _
CEILIN R_
DUCT WORK PI ING IN UNHEA EO
SPACES
REMARKS :
ARRIVE
DEPART
I NS PEC TOR
awn
BUILDING and ZONING DEPARTMENT
i Bay and Haviland Road, R. D. 1 Box 98
[f QueensburY, New York 12801
# f
SEPTIC DISPOSAL. SYSTEM INSPECTION
NAME � 1
LOCAT I ON
DATE PERMrT NC7, j
1 SOIL TYPE Loami
Percolati n _ Clay -
_ Q T st R guired? YES -. NO
Percc'1vF r .i
ate - Mn/Inch j
f TYPE of SYSTEM:
! Abs Orptton field, tal leng h_ i
Length of each tree h -- �
Depth of trenches
Size of gravel r
SEEPAGE PITS{Nwnber f} t
size- ft x t. {
Gravel size
PIPING : S ze
Bldge to tank Type
f. Tame to dist. box
Disto box to field/
oPenings sealed? NO
I
LOCATXON/SEPARATION j
I Foundation to tank
1 Foundation to
abso ied . ft.
Absorption to lot
Separation of pi ft. r
LOCATIC pF SYST
_.-- ON P PERTY �
Front (clXcle one)
COMMENTS : Et side .T� Right side
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SYSTEM USE APPR.OVEL7�'^ Y p
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Building Ins)pector
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FILE COPY
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