1992-054 r _ � f Y • �
CERTIFICATE (0F COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
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Date ,22yla ov I4
This is to certify that work requested to be done as shown by Permit No. 92- 054
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has been completed.
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1" This structure may be occupied as a septic System
AWisconsin Av
Location
Helen Barlow
Owner
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. do Code Enforcement
BUILDING PERMIT
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TOWN OF QUEENSBUR4' No, 92_ 054 �
WARREN COUNTY, NEW YORK i c
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PERMISSION is hereby granted to Helen Barlow
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OWNER of property located at 9 Wi scan O n Av Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Septic alteration ru
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.
S_ OWNER'S Address is
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2. CONTRACTOR or SUI LDEWS Name
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T . Fortino Excavating z
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3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5_ ARCHITECT'S Address
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S_ TYPE of Construction — (Please indicate by X)
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( i Wood Frame ( I Masonry [ 1 Steel
FPLANS and Specifications
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No. Septic alteration to include 1000 gallon septic tank , one seepage pit _
10 ` with #3 stone at 2 ft de th as era lication and lot Ian .
roposed Use
Septic system
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MOOFebruary 19 �e 94 0
$ PERMIT FEE PAID - THIS PERMIT EXPIRES
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the rD`
town of Queensbury before the expiration date) '%
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Dated at the Town of Queensbury this 19 Day of February 19. 2
SIGNED BY C ✓ - for the Town of Queensbury
$wilding and Zoning nspector
TOWN OF QUEENSBURY
TOWN OF QUEENSBURY REG E1VEp
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # Z112
FEB f7 W
Date : t� BLDG. PfflYM OdOP
LOCATION OF PROPERTY IlFOR INSTALLATION :
Owner ' s Name : 1:p 1 eptle V�3,r`L"J
Owner ' s Mailing Address :
Installer ` s Name : �, fl- %ej ,lty Phone # : 13 C96
Number of bedrooms ( if residential ) :
Total daily flow ( residential - compute 150 per bedroom ) :
Topography-Circle One : Flat C; •11 Steep Slope % of Slope
Soil Nature-Circle One : r Sand Loam Clay Other /Depth :
Ground Water-At What Depth ? Feet
Bedrock or Impervious Material - At What Depth ? Feet
Percolation Test- Circle One : Not Reou ,ne d Required/Rate Min . Per Inch
Domestic Water Supply- Circle One . Muni clpal...-� Well Other
If domestic water supply is a weT1---
Separation : Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank J1 000 gal . ( Minimum size : 1 , 000 gal . )
Tile Field : Each Trench feet/ /Total System Length feet
Seepage Pit ( s ) : Number of / Size each : ft . x ft .
Size of Stone to be used : # / Depth or Thicwass feet
HOLDING TANK SYSTEM IF REQUIRED
No . of Tanks Sizelof Each Gal .
Alarm system and associated electrical work to be inspected— y 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 t Town of Queensbury Sanitary Sewage Disposal
Ordinance .
SIGNATURE OF RESPONSIBLE PERSONx DATE : c Lie-
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 alll tanks , distribution boxes , tile fields
and/or drywel l s
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 :
, ,-lL a 2' Z 00 A
a OWI't of Queer 31 " r y
" BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
LOCAT I ON DATE , -
� JL4/-22.---PERMIT NO . O:i
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SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES
- NO
Percolation rate - Min/Inch -
TYPE of SYSTEM: �..-'
Absorption field , total lent � �r Length of each trench
Depth of trench
size of car
SEEPAGE PITS4Numbex cf
Size- s " ft. X _ft .
Gravel size s1ze Type
PIPING : ( �jrf .
'Bldg . to tank � �,�
Tank, to dist . box
Dist. box to fief YES Q partial
Openings sealed .
LOCATION/SEP^ARATIONS : f t.
Foundation to tank tion ft
Foundation to absorp ft . P LAAjo
Sew
Absorption to lot line f
Separation Of pits
LOCATION 5YS PRQPERTY (circle one)
Front --
ea - Left si - Right side -
CCMMENT
SYSTEM USE RPPROV'E410i
NO
B spe for
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�ourn o� '�tteen36a~er�
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Sox 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME.-
LOCATION p
DATE .. l PERMIT NO.
SOIL TYPE _ Sand. - Loam - Clay
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM.
Absorption f ieldo total length
Length of each -trench
Depth of trenches
Size of gravel
SEEPAGE PITS4Number of
Size- ft. X _ ft
Gravel size
PIPING . ize Type
Bldg . to tank.
Tank to di.st. box
Dista boas to field/pit - -
Openings sealed? YE51 Nm0 Partial
LOCATION/SEPARATIOKiS.
Foundation to tanks' ft.
Foundation to absorption ft .
Absorption to 1 line ft.
Separation of is It.
LOCATION OF SYSTEM CYN PROPER Y Ccircle one)
Front - Rear - Left side - Ri ht side ..
CC MMENTS
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OW►I.�`tV- Or/�-v XA--c,L=.'c. f X c7P�rz ey ,
SYSTEM USE APPROVED Y i3
Building gtnsr
tor
01/86 and vl
DEB I h 199Z
BLDG. & CQDE DEPT.
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TOWN OF UFFNSBURY
BUILDING DEPT.
REVIEWED BY
DATE >- i I