1991-176 .<, Jo/-7 /0 • ,
CERTIFICATE OF COMPLIANCE •
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 40/19 /2 19 9/
This is to certify that work requested to be done as shown by Permit No. 91-176
has been completed.
Septic Alteration
This structure may be occupied as a
Location 12 Park View
Owner Robert Doran
By Order Town Board
TOWN OF QUEENSBURY
Whi/
4/71. -/ AW,
Director of Bldg. & Code Enforcer,nent
A
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-176
WARREN COUNTY, NEW YORK
)
PERMISSION is hereby granted to Robert Doran
OWNER of property located at 12 Park View 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
2. CONTRACTOR or BUILDER'S Name
Queensbury Sewer
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction— (Please indicate by X)
( )Wood Frame ( ) Masonry ( ) Steel ( )
7. PLANS and Specifications
No. Septic Alteration to include: 120' Tile Field with #2 Stone,
10" Thickness
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 11, 19 93
(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 filth Day of . April 19 91
r / /
SIGNED BY \.� G _,; / for the Town of Queensbury
Building and Zoning Inspector
/lft TOWN OF (,SUE SBURY
� j APPLICATI FOR SEP C; I L PERMIT
c T'Usr,:0.' (+F QI EEP4$ R
DATE: re79,(4 f-- 7
LOCATION OF PROPERTY72( c(
FOR INSTALLATION APR 1 0 1991
Owner' s Name: 1r ( N Ira_ j I BLDG. ci, k Jt
EP�'o
Address: P 0/6? cc)
Installer' s Name: 6-Luc to V� u Icti-v-ITelephone:717.--_236
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: Circle one: lat Rolling Steep Slope % of Slope
Soil Nature: Circle one: Si` Loam Clay Other /Depth:
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what depth? Feet
Percolation test: Circle one: -not require required
Rate .- Min. Per Inch
Domestic water supply: Circle one K Munici,p.a.1) Well Other
If domestic water supply is a well :
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank&--v gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench e feet/Total system length /7-2& feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
/Depth or Thickness 2 ' feet
Size of stone to be used �i�. �- �-
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HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks • Size of Each Gal.
*Alarm system and associated electrical work to be inspected by an approved
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: ----�. ,-' �i/ DATE: l - �` ��
1
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_• .14etiC 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 co 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 drywalls
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 chi: system by chi installer and a fine f,
uf up co $250.00.
C. An approved copy of the plot plan shall be available on the construction o
site. Failure co produce said plot plan at time of inspection may
result in an immediate work'Stoppage.
D. Should unforeseen problems during construction prevent' proper installa-
cion, alteration or repair of an approved system. a new,proposal must
bu submitted co the Queensbury Building Department before further
construction.
Town of Queensbury
.BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
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k.awrks: •
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awn ol Queeniburt� /40
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
��I
NAME ,F.g'",r
LOCATION / AAA. I J
DATE 4//0/ 7/ PERMIT NO. i e4`// 74o
SOIL TYPE - Loam - play -
Percolation Test Required? YES
YES - NO
Percolation rate - Min/In6
TYPE of SYSTEM: +�{ ,
Absorption field, total length /, ?B
Length of each trench ,
g ?in, ,sr •
Depth of trenches v2 ' J ,1
Size of gravel -0 ;i
SEEPAGE PITS4Number of) FI'
Size- ft. X ft. s'.j
Gravel size . {, r
PIPING: S•'ze Type
Bldg. to tanks t-7 -�
Tank to dist. box r7`y Pvc
Dist. box to field/pits` ly ii
Openings sealed? E;O NO Partial
t
LOCATION/SE?ARATIONS`:
Foundation to tank/ ¢ 4 ft.
Foundation to absopption p ft.
Absorption to lot/line n V ft.
Separation of pi s 7 ft.
LOCATION OF SYST M ON' PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS .
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SYSTEM USE APPROVED Nei /
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!.i 7ng nsp• tor
01/86 and vl
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i I TOWN )rirEFcCgi2gSBURY•
APR 1 0 1991
TOWN OF QUSJJRY BLDG. & CODE DEFT,
BUILDING & 4 DEPT.
REVIEWED BY
DATE /40'