1992-037 LIAM
�ER,TIFI A"TE x0v + O1VIP
TOWN OF QUEENSSURY
WARREN COUNTYI, NEW YORK
L�late �d - -19 12,
This is to certify that work requested to be done as shown by Permit N O*IIIIIIIIIIIIIm92-U37
has been completed.
This structure may be occupied as a
Septic altetation
I
i 1(3+� W' Aviation k0ad
1 oration
Owner Ka Anderson
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No. 92-037 W
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Kay Anderson •I
OWNER of property located at 177 Aviation Road Street, Road or Ave. �4
in the Town of Queensbury, To Construct or place a Septic ,Alteration
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. 9b
Ct.
ro
t. OWNER'S Address is
19 Cord Drive
Latham , NY 12110
2. CONTRACTOR or BUILDER'S Name
Jack Hall Plumbing A heating
3_ CONTRACTOR or BUILDER 'S Address
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4. ARCHITECT'S Name
J
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5. ARCHITECT'S Address. �
Cy3.
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6. TYPE of Construction — (Please indicate by XI O
J
( I Wood Frame ( 3 Masonry ( 1 Steel I I
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7. PLANS and Specifications
No. Septic Alteration to include . 2 seepage pits each 7 ' x 7 ' using
#3 stone , 2 ' Thickness as per plot plan specifications and application f �,
1 �
S. Proposed Use
Septic Alteration
$ 25 AO PERMIT FEE PAID — THIS PERMIT EXPIRES � February 4 . ig 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 Queensbur this yJ .ay of Fehruary 19_92L__
SIGNED BY for the Town of Queensbury
Building artVaning Inspector
TOW*d of QUEENSBURY I�,�2 _ r
APPLICATIM FOR SEPTIC DISPOSAL PERMIT
��rr--~~- TOWN OF QUEENSBURY
DATER I�F'" �" ` _ RECEIVED
LOCATION Of PROPERTY FOR INSTALLATION f ? /. L9 ,r41 1992
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Owner ' s Name: /A y'
Lit: Ut�FFTO
Address : 19 C49 e .hC37�,��� vim'
Installer ' s Name : naOtf 11011 P uvAbrk5 y He06jelephone :
Number of bedrooms ( residential only )
Total daily flow ( compute @ 150 gal per bedroom )
Topography : Circle one : trlat Rolling Steep Slope % of Slope
Soil Nature : Circle one : and Loam Clay Other /Depth :
Ground water : At what depth? Feet
Bedrock or Impervious Material : At what depth ? -�� Feet
Percolation test : Circle one : ot�rui required
Rate - a -- Min . Per Inch
Domestic water supply : Circle one : Muni i Well Other
If domestic water supply is a we
Separation : Water supply from any septic absorption feet .
PROPOSED SYSTEM. Septic Tank '/,dr'�c gal . ( minimum size : 10000 gal )
TILE FIELD : Each Trench feet/Total system length feet
SEEPAGE PIT( S ) 0 Number of / Size each feet
by � feet
Size of stone to be used 3 /Depth or Thickness 4;2 feet
ww�r#,rsr*sr,irsr�,►,�rsr,ts ,r,ir,►�rw.+�r,.,►,i.,�
HOLDING TANK SYSTEM IF REQUIRED
NO . of Tanks Size of Each Gal .
*Alarm system and associated electrical work to be inspected by an approw+!
agency.
I have road the regulation on the reverse side of this shoot and agree to abide
by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance .
SIGNATURE OF RESPONSIBLE PERSON . "' � _ C _DATE ** /"`eAe5�0 �V `�' -Z
i
Seocia System Ine2ections
A . All applications for septic systow installationo alteration or repair .
as required by the Town of Quesnsbury Sanitary Sewage Ordinance . shall
br submiresd co the Kuilding Dopartmsnc at Losac 24 hours before start
of construction and shall include a plot plan Showing :
l . ) Cho proposed location of Cho system
2 . ) locacion and distance to loc lines
3 . ) location and dLstance to scruccures
4 . ) location and discanca Co any water supply
S . ) size and dimensions of all tanks , distribution boxes ,
vile fields an" / or drywalls
8 . No system shall be covered before inspection and approval by the
ouilating Inspuctor . Failure to comply with this requirement. may
r ,:441C in the uncovering of Chw system by the installer and a fine
�jf up to $ 250 . 00 .
ca An approved copy of the ploc plans shall be available on the construction
site . Failure to produce said plat plan at dams of xnspecciom may -
russu.It in an inssediace work scappage .
D . Should unforeseen problams during construction prevesat proper iadacalla�
clan , alteration or r.sp.&Lr of an approved syscem, a now proposal must
bu submictad to Cho Quwunsbury Building Departsonc before further
4oesecrucCion .
Torn of Queemobury
RU I l.D r NG and CODES DEPAATMM
Bay and Naviland itoada
Qusenssbury , Now York 12904
{`l/ ....lawn C1� �iteen3a�efrt�
BUILDING and ZONING DEPARTMENT
Bay and Maviland Road, R. D. 1 'Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
LOCATION
DATE - 1 ! �1 Z- PERMIT NO .
SOIL `TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch _
TYPE of SYSTEM:
Absorption field , total 1 x err
Length of each tren rf ��
Depth of tre
Size 4�. avel
SEEPAGE PITS4Numbe of)
Size- �ft. X _ ft.
Gravel size
PIPING : Siz Type
Bldg . to tank ArGl �
Tank. to disco box vin
Distm box to field/p • t 2 rL-- -
openings sealed? Es No Partial
LOCATION/SEPARATIONSO
Foundation to tank ;r[45W ft.
Foundation to absa tionf
Absorption to lot ine fC �-
Separation of pit ft.
LOCATIONS OF SYS ON PROPERTY (circle one)
ro - Rear - L t side - Right side -
C TS :
SYSTEM USE APPROiTED /YES Nq
I .. /
Sui ding I spector
01/86 and vl
TOWN OF QUEENSBURY
RECEIVED
FEB 3 1992
BLDG. & CODE DEPT.
-
G` ;A ;,,
81.3 L EP7 .
REVIEWED" BY
DATE
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