1991-191 I,
. .
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 11 19 it
This is to certify that work requested to be done as shown by Permit No. 91-191
has been completed.
This structure may be occupied as a Septic alteration
Location 4 Hughes Court
Owner Jack Lebowitz
By Order Town Board
TOWN OF QUEENSBURY
/././
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-191
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Jack Lebowitz
OWNER of property located at 1/.Hughes Court Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Septic Alteration N
at the above location in accordance to application together with plot plans and other information hereto filed and Gwi
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
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2. CONTRACTOR or BUILDER'S Name e+
Condon's Septic & Drain N
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3. CONTRACTOR or BUILDER'S Address c
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4. ARCHITECT'S Name -s
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( I Steel ( ) O
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7. PLANS and Specifications
No. Septic Alterations to include: 1 seepage pit 10' x 8' with #3 stone
2' Thickness as per plot plan specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 15, 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 15th D yo f April 19 91
SIGNED BY \ /',l✓• for the Town of Queensbury
Building and Zing Inspector
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+� ) TOWN OF QUEENSBURY
;11r ( —l9 APPLICATION FOR SEPTIC DISPOSAL PERMI
1
DATE: --j (
LOCATION OF PROPERTY FOR INSTALLATION / /7 'l7�g O`/ TO N RECFRiP NsBl1RY
Owner' s Name: TACK' LF, w r L, APR 121991
Address: /4[i W l 7e ('' ?r9FAii.S()O-I:— 1.�-Y ,/1 7
Installer' s Name: ( rJcL&uS cc4DA.4)-lili Telephone: G
Number of bedrooms (residential only) `2.
Total daily flow (compute @ 150 gal per bedroom) 0 (5
Topography: Circle one: Flat Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand Loam Clay Other /Depth:
Ground Water: At what depth? /1�,4 Feet
Bedrock or Impervious Material : At what depth? /U>/A Feet
Percolation test: Circle one: not require required
Rate - Min. Per Inch
Domestic water supply: Circle one: 61unicip. Well Other
If domestic water supply is a, well :
Separation: Water supply from any septic absorption feet.
Coci-&-FL
PROPOSED SYSTEM: Septic Tank (Opo 041. gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of 1 /Size each ` ) feet
by feet
Size of stone to be used #. 3 /Depth or Thickness r2, feet
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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: fC -Qt / DATE: `/?"4g/1
�a.
1
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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
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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 anal/or drywalls
B. No system shall be covered before inspection and approval by 'the
Building Inspector. Failure co comply with this requirement may
result in the uncovering of the system by the installer and a fine
of up to $250.00.
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C. An approved copy of the plot plan shall be available on the'".construccion
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 properinstalla—
tion, alteration or repair of an approved system, a new proposal must
be 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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awn of Ueen3rhury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC� DISPOSAL /SYSTEM INSPECTION
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NAME U 0-aa \ILi49'/``
LOCATION slemi,K,9
DATE t/7 / %2" PERMIT NO. 91-19/
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM: \
Absorption field, total length o'�.`,'n"1
Length of each trench ' f0 1
Depth of trenches S -
Size of gravel
SEEPAGE PITS{Numbe of) _
Size- ft. .X f .
Gravel size
PIPING: SJ;_ e, Type
Bldg. to tank
Tank to dist. bo '' /�C
Dist. box to fie' d/pit /29
Openings sealed YE`' NO Partial
LOCATION/SEPArP TIONS:
Foundation t• tank ft.
Foundation • absorption ft.
Absorption o lot line
Separatio of pits /�� � ft.
LOCATION OF SYSTEM ON�P'OPERTY(circle one)
Front - , . ✓ -4eft sid Right side -
COMMENTS:
SYSTEM USE APPROVEI411D NO
B i ding Inspe or
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BUILDING'.w G DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME 1 k"( 0 �CTCi Z_
LOCAT ION LI auc t 4-e G, LJ-a-
DATE `Y/7i ` I PERMIT NO. 9l"i G
SOIL TYPE - Sand - Loam - Clay -
Percolation Tes Required? YES - NO
Percolation rate'- Min/Inch _
1
TYPE of SYSTEM: J
Absorption field al trenches ' ,
ize of gra ?
SEEPAGE PITS{N1nber of) • ,/ 1
Size- g ft. x; Ip ft. /
Gravel size ; 41 :
PIPING: Size Type
Bldg. to tank I OU L
Tank to dist. box VC_
Dist. box to field/pit
Openings sealed? AP NO Partial
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LOCATION/SEPARJTI,ONS:
Foundation to tank /47 ft.
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Foundation to porption 30 ft.
Absorption to l t line '3 0ft:1- -
Separation of p pits �ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - earif Left side - Right side -
COMMENTS:
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SYSTEM USE APPROVED YES NO
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Bui ding sp ctor
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BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
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SEPTIC DISPOSAL SYSTEM INSPECTION
NAME Ok O i -
LOCATION i ( ) ,-) aPif1A-v:
DATE .. ///1) PERMIT NO. 9) _ / ci /
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SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate -; Min/Inch
TYPE of SYSTEM: ,
Absorption field, total length I'
Length of each trench ' /
Depth of trenches t /
Size of gravel r
SEEPAGE PITS{NumbQX of) • ,1
Size- ft. X g ft.
Gravel size , ;,�° •
PIPING: 81ze Type
Bldg. to tank }} ;r •
Tank to dist. box-
Dist. box to field'/"pit•
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Openings sealed? ? YES NO Partial
LOCATION/SEPARATIONS:
•Foundation to ,tank) ft.
Foundation to,„absorption ft.
Absorption to lot 'ine ft.
Separation/Of pits;, ft.
LOCATION OF SYSTEM SON PROPERTY(circle one)
Front - Rrear - Leftr:? side - Right side -
COMMENTS:
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SYSTEM USE APPROVED ES NO
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