1991-170 _ .
CERTIFICATE OF. COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Apri I 30 19 91
This is to certify that work requested to be done as shown by Permit No. 91-170
has been completed.
This structure may be occupied as a s-astic al tprati on
Location Sawn Road
Patrick Howl and
Owner
By Order.Town Board
TOWN. OF QUEENSBURY
44 j")..04
Director of Bldg. & Code Enforcement
•
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-170
WARREN COUNTY, NEW YORK
Howland Lc)
PERMISSION is hereby granted to Patrick I#p,�d ( .� CD
OWNER of property located at Stewart Road Street, Road or Ave.
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.
1. OWNER'S Address is
Same
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2. CONTRACTOR or BUILDER'S Name r—
Smith Excavating
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3. CONTRACTOR or BUILDER'S Address r+
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address 0
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CD
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6. TYPE of Construction—(Please indicate by X)
Z
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( )Wood Frame ( ) Masonry ( I Steel ( )
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7. PLANS and Specifications
No. Septic alteration to include 2 seepage pits each 8' x 8' using #2 Store
thickness 16" 0
8. Proposed Use N
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 10, 19 93 -a
(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.) n
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Dated at the Town of Queensbury this 10th Day.of, April 19 91 r`+o
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SIGNED BY � /�l; for the Town of Queensbury o'
Building and Zon(925 Inspector
TOWN OF QUEENSPURY
-104 Cr25,,F. Ual+lait/HY.
- "� <-'' APPLICATION FOR M Iri',l'"'`'�
SEPTIC DISPOSAL PERMIT APR 91991
BLDG. & CODE DEPT.
DATE 0/9/
LOCATION OF PROPERTY FOR INSTALLATION 5J /A '/ ,es
Owner's Name: 6, - (j,00//dJid Telephone:
Address: ,57 �„j
Installer's Name: (5 /IV L C- (� J 17 Telephone: ��?(��(J�,1
Number of bedrooms (residential only) 3
Total daily flow (compute (a 150 gal per bedroom) '
Topography: Circle one: Flat Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand oam Clay Other /Depth: Feet
Ground Water: At what depth? Feet
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle one: not required required rate min. inch.
Domestic water supply: circle one Municipal Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM: Septic Tank a1Sf1fLd gal. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of . / Size each C id feet by feet
Size of stone to be used # 3 /Depth or Thickness /16 .I. feet
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 S itary Sewage Disposal Ordinance.
SIGNATURE,0 ,
RESPONSIBLE PERSON: /
&WN OEDATE: ��/ QUEENSBURY
OVER BUILDINAit CO PES DEPT.
REVIEWED B _ /_, 6 -"'
DATE 7��4 /fi
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 all 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 an immediate work stoppage.
D. Should unforeseen' problems during construction prevent proper installa—
tion, alteration or repair of an approved system, a new proposal must
be submitted to the Queensb'ury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT.
Bay and Haviland Roads
Queensbury, New York ,12804
Rum:arks :
VW
_town o/ Queenibur y .
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME �cr�e�
LOCATION
DATE y / )9 PERMIT NO. 91 —/ W)
SOIL TYPE Sand - Loam - Clay -
Percolation Test Required?
Percolation rate - Min/Inch r,
TYPE of SYSTEM:
Absorption field, total length
Length of each trench '
Depth of trenches
Size of gravel ? _
SEEPAGE P S{Numbe of) ) s
Size- ft. X ft. 6 1 .
Gravel size 3 �; f
PIPING: S' T p
Bldg. to tank j�� •
Tank to dist. box 7 ;
Dist. box to field/pit Ail;
Openings sealed? YES Q; Partial
iE
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption ft.
Absorption to lot line ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS: \Q \-\e c K
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SYSTEM USE APPROVED dp NO
Bu ding Inspec or
01/86 and vl
awn o/ Queen3tury 4
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSALSYSTEM INSPECTION
NAME p/.rf/Wi / //`� W'/
LOCATION /i ,/g,/,/t-. I aW/,//-41 /%
DATE_ / 1/ 9/ PERMIT NO. `0-17Z)
SOIL TYPE - Sand - Loam - Clayt-
Percolation Test Required? YES - NO
Percolation rate - Min/Inch : •
TYPE of SYSTEM: +'
•
Absorption field, total length
Length of each trench
Depth of trenches '
Size of gravel
SEEPAGE PITS{Number of)
Size- ft. X ft. ''hP
'P
Gravel size ,
PIPING: Size !, Type
Bldg. to tank y ;,
Tank to dist. box _ I
Dist. box to field/pit
Openings sealed? YES yPO ' Partial
t.
LOCATION/SEPARATIONS:
Foundation to tank t$kr ft.
Foundation to absorption f;'t.
Absorption to lot line , ft.
Separation of pits
LOCATION OF SYSTEM ONFPROPERTY(crcle one)
Front - Rear - Left side - Right 'side -
COMMENTS: 9
"7ee_6Z, 61-4/1/110-0-e c,92e Adi,--7cra•
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SYSTEM USE APPROVED YE 60
Bui ing Inspe or
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loc
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