1991-188 , r }
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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date !.,. i./,/. 19 19 Zi
This is to certify that work requested to be done as shown by Permit No.
91-188
has been completed.
This structure may be occupied as a
septic alteration
20 Linden Av
Location
DIRCK HARRISON
Owner
By Order Town Board
TOWN OF QUEENSBURY
(:D/
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No. 91_188
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Dirck Harrison
cri
OWNER of property located at 20 Linden Av 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
Sanders Excavating
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
r—
J.
5. ARCHITECT'S Address
rD
•
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( ) Steel ( ) e
7. PLANS and Specifications
No. Septic alteration to include 200 feet of tile field with #2 stone
at 1 ft depth as per plot plan, specifications and application.
J.
8. Proposed Use
Septic alteration
25.00 April 12 93
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(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 . 1?th Day o April 19 91
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
/�► TOWN OF UEENS URY hh 1
;..41 � APPLICATION FOR SEP S L PERMIT pl�.
DATE: ('? / v g ., uRY
LOCATION OF PROPERTY FOR INSTALLATION ..%?C /)9a/en •
l Arty 12 101
Owner's Name: 'u1 I�CG[ 1/4 `'1i'/5-63r�
� BLDG. & CODE DEPT.
Address: 9-) j,V4c/rc11 11' vet/1s12 ry
Installer' s Name: /c5 f U � ��, ���� Telephone: 7 ,Y //�"
Number of bedrooms (residential only) -3
Total daily flow (compute @ 150 gal per bedroom) h/,5 O
Topography: Circle one: 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 `riot:required required
Rate - Min. Per Inch
Domestic water supply: Circle one: .Murp Well Other
If domestic water supply is a well :
Separation: Water supply from any septic absorption feet.
r/x 1Liv47
PROPOSED SYSTEM: Septic Tank /€ Oc' gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench 6-0 feet/Total system length 4P-0 C) feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used it . /Depth or Thickness / feet
*****************************
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: �% � DATE: LG�i�i�1s2 Q/
WW1 System Insuctions:
tic siysces installation, alteration or repair,
A. All applicaelons for sop
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 co structures
4.) location and distance co any water supply
5.) size and dimensions of all tanks, distribution boxes,
cile fields and/or drywalls
B. Nu system shall be covered before inspection and approval by the
uuild ing Inspuctor. 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 inscalla•
cion, alteration or repair of an approved system, a new proposal oust
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
k‘Aiarks:
•
•
•
/.' Jown o/ Queenihurty
. BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801 477/
'a.
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME X,�a CL `/YGL5 po r--L.)
LOCATION 44 D a4(��d i ) `fit/
DATE/ / V PERMIT NO. VP/89/
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
r
Percolation rate - Min/Inch'
TYPE of SYSTEM:
Absorption field, total/length
Length of each trench • ]
Depth of trenches -Z-V
. Size of gravel e?. .
SEEPAGE PITS4Number cf) -
Size- ft. X ;}ft. •
Gravel size , ';. /
PIPING: '';I.%
/ Size Type
Bldg. to tank ,Tank to dist. box - - Piic
Dist. box to fiel1d/ptit y" pyc_,,
Openingssealed2YES NO Partial
.�
LOCATION/SEPA NTIONS:
Foundation to tank lc. ft.
Foundation to absorption ft.
Absorption to lot line ‘ •)S ft.
Separation pf pits ; ft.
LOCATION OF YSTEM ON• PROPE my(.C.jrcle one)
Front -� Left side - Right side>
COMMENTS: �,
I
I
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t ,
V.
•
I
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SYSTEM USE APPROVED NO .0
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Bu` ing Inspe for
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APR 12 1991
• BLDG. & CODE DEPT,
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