1992-122 CERTIFICATE OF +C(]1VIFiLI.ANCE
TOWN OF QUEENSSURY
WARREN COUNTY, NEW YORK
Date April 8 14 .92
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` ested to be done as shown by Permit No. 2' 122
TNis is to certify that work r,EQu
This
has been completed.
This structure may be occupied as a
2 5 tester Drive -
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Joseph 9eybolt
i Owner
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. do Code Enforcement
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BUILDING PERMIT
TC)11+"VN OF QUEENSBURY 92_122 �
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WARREN COUNTY, NEW YORK rl�
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PERMISSION is hereby granted to Joe Seyh01 t
OWNER of property located at 216 Lester Drive Street, Road or Ave.
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Septic Alteration
in the Town of Queensbury, To Construct or place a Se�
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.
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1. 0VVNER'S Address is
same
2. CONTRACTOR or BUl LDE R'S Name 1�+
Naylor Excavating
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3_ CONTRACTOR or BUILDER ^S Address.
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4. ARCHITECT'S Name
5. ARCHITECT'S Address fop
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G. TYPE of Construction — (Please indicate by X)
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{ ) Wood Frame ( I Masonry { I Steel ( T Z
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7. PLANS and Specifications
1
No. Septic Alteration to includes no ' of Tile Fields #2 Stone
2 ' Thickness as per plot plan specifications and application
B. Proposed Use
Septic Alteration
$ 25- 00 PERMIT FEE PAID — THIS PERMIT EXPIRES ., April 7 s 19 94'
(lf 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 axpiration date.)
Dated at the Town of Queensbury this h pay of April 19 92
SIGNED BY for the Town of Queensbury
Building and Zoning I ctor
TOWN OF QUEF&St@il YOF QUEENSBUH r
APPLICATION FOR SEPTIC DISPOSAL a FFIVED Permit #
Fee Paid �--'
APR 6 199Z
Date : viewed By
BL.DG. & CyDE DE�
LOCATION OF PROPERTY FOR INSTALLATION :
Owner ' s Name :Owner ' s Mailing Address�•/ �s���
Installer ' s Name : V Cam. . '` ��?? Phone # : �-
Number of bedrooms ( i f residential ) :
Total daily flow ( residential -compute @ 150 gal . per bedroom ) :
Topography-Circle One . F:1ajtD Rolling Steep Slope % of Slope
Soil Nature- Circle One : K Sand Loam Clay Other /Depth :
Ground Water-At What Depth? Feet
Bedrock or Impervious Material -At What Depth ? Feet
Percolation Test- Circle One ; Not Required ed quired/ Rate Min . Per Inch
Domestic Water Supply- Circle One : Well Other
If domestic water supply is a well -
Separation : Water supply from any septic absorption S� feet
PROPOSED SYSTEM: Septic Tank -� al . ( Minimum size . 1 , 000 gal . )
Tile Field : Each Trench feet//Total System Length feet
Seepage Pit ( s ) : Number of f+' 1 'Size each : ft . x ft .
Size of Stone to be used : # Z / Depth or Thickness Z" - feet
HOLDING TANK SYSTEM IF REQUIRED
No . of Tanks Size ' of Each Gal .
Alarm system and associated electrical work to be inspected by 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 the Town of Que{ensbury Sanitary Sewage Disposal
Ordinance .
SIGKATURE Of RESPONSIBLE PERSON : DATE : �� �7
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 .
Co 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 :
Sown of 'Queenshury T
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATIONrF
DATE , PERMIT NO.
SOIL TYPE - cA d'r Loam - C1aY -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch -
TYPE of SYSTEM:
Absorption field , ' otal 1er�th
Length of each tr ch 3
Depth of trenches '
Size of gravel_
SEEPAGE PITS-4Numbe of?
Size- ft. X _ t •
Gravel size
PIPING :
xe� TyPe
Bldg _ to tank '
Tank. to 3istm box
pvry�
Dist. box to field/p t j.—Ae
openings sealed? NO Partial
LOCATION/SEPARATT s : y� ft.
Foundation to tan C ft .
Foundation to abs rption
Absorption to to line /) f-t`
separation of P s
LOCATION OF SYS ON 'p.RO]PERTY {circle one)
Front - Rear - eft s ' -� Right ` side -
CCMMENTS :
SYSTEM USE APPROVE,( YES
Bui. ldin Inspector
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TOWN OF 4UEENSBUhi.
RECCIVED
APR G 1992
BLDG. 8 CODE QuP'T
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