1992-125 1 7r
CERTIFICATE of COMPLIANCE
TOWN OF QUEENSSURY
WARREN COUNTY , NEW YORK
Urate Ll i!�0 _ 19 L-
This is to certify that work requested to be done as al+own by Permit No.
has been completed-
"his structure. may be occupied as a Septic Alteration
L oration
Owner Yi l l i am Hu Tres
By Order Town Board
TOWN OF QUEENSSURY
Director of Bldge do Code Enforcement
r�
Owl
x
BUILDING PERMIT �
TOWN OF QUEENSBUR.Y No. 92_ 125
WARREN COUNTY, NEW YORK
t "l
I.i
I
ram.
PERMISSION is hereby granted to _. William Hug es Ira
OWNER of property located at Box 203 Luzerne Road Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Septi C Al terati an
at the above location in accordance to application together with plot plans and other information hereto filed and tC
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. 1ii
H
r
1. OWNER'S Address is
Sane
r.
2. CONTRACTOR or GUI LDER'S Name
Smith ' s Excavating
3- CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
&. TYPE of Construction — (Please indicate by X)
{ } Wood Frame f I Masonry i ) Steel l }
7. PLANS and Specifications
N.- Septic Alteration to include : 1000 gal _ Tank wr/1 seepage pit 8' x 10 '
#3 stone , 2 ' thickness as per plot plan specifications and application
S. Proposed Use
Septic Alteration
$ 25- 00 PERMIT FEE PAIL? — THIS PERMIT EXPIRES April 7 , 19 94
(if a longer period is required an application for an extension mush be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury t r7th tla o April 1992
5
SIGNED BY for the Town of Queensbury
$u iId ing and Zo " i nspe ctor
TO MIN OF Q UEENS B U R Y T,6
APPLICATION FOR
SEPTIC DISPOSAL PERMIT APk
BUILDING & CODE DEPT.
DATE ``
LOCATION OF PROPERTY FOR I STALLATIONU
c� ) / --~
Owner's Name: 'f �� � Telephone: / ` �( � �
Andress: .� ` �[ L� .; u �3r�� �t �rIs
e
'"�YG. � I�r PaY^^
1
Installer's Name: -= r � ' � c' � " ' l Telephone: 7 J
Number of bedrooms (residential only)
Total daily flow (compute (d 150 gal per bedroom)`
Topography: Circle one: Rolling Steep Slape 415 of Slope
Soil Nature: Circle on Sand Loam Clay Other /Depth: Feet
Ground Water: At what depth? _ Feet
Bedrock or Impervious Material; At what depth ? Feet
Percolation test: Circle one; ( oR t require required rate min. inch.
Domestic water supply: circle one: ( 7tinicipa Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank ,! �fc�r� gal. ( minimum size. 1 . 000 gal.)
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of / Size each r feet by feet
Size of stone to be used /Depth or Thickness � 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 Sanitary Sowag
Disposal Ordinance.
SIGNATURE QF R SPONSIBLE PERSON*
1 ]
DATE: .� y
OVER
L
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
he submitted to the Queensbury Building Department before further
construction .
Town of Queensbury
BUILDING and CORES DEPARTMENT
Bay and Haviland loads
Queensbury , New York 12804
._./own o/ Queen36ure�
BUILDING and ZONING DEPARTMENT
Bay and Havtiand Road, R. D. I Box 98
Oueensburyr, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION
DATE I /— 7dA� PERMIT NO,
SOIL TYPE - Sand - Loam - Clay
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field ,
Length of each_, txench
Depth of ..tre'nches
Size-Xik gravel �7 '�"�7`-----
SEEPAGE P ITS{Numbe of) �--
Size- _-SLft, X f ft.
Gravel size
PIPING : Size Tye
Bldg . to tank if
Tank to dist . box
Dist. box to field r_ � PV
Openings sealed? Ei NO Partial
LOCATION/SEPARATION
Foundation to tank ft.
Foundation to abso tion ft, 1J�
Absorption to lot i e £t .
Separation of pi /Y ft
LOCATION OF SYS PROPLTY(circle one)
Front - ear - eft s de - Right side COMMENTS"
:
d
SYSTEM USE APPROVED E NO
_ r
Building ins a ' or
01/86 rnd v1
50
� . w . , . .
i�} yy'Y 1 y♦ �i �
■� i..Y t 1
APR li
1992
i /BUJLDING & CODE DEPT,
T
0r- j /
TOWN OF QUE 1,4SSURY
BUILDING & CO y S DEPT.
REVIEWED BY .`
DATE ` ? x-