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1992-194 I - 5 r i CERTIFICATE Or COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY , NEW Y©RK Date LZ f 1992194 • IThia is to certify that work requested to be done as shown by Fermi[ No. " has been completed. This structure may be occupied as a Septic Alteration ! C''�C1 Cl t C.Al I..ocatian E Omer Helen Memi tt By Order Town Board TOWN OF QUEENSBURY Director of Bldg. do Code Enforcement rSIr wIIII ae BUILDING PERMIT � TOWN OF +QUEENSBURY Na 92_ 194 WARREN COUNTY, NEW YORK c cc I PERMISSION is hereby granted to Helen Memmi tt OWNER of property located at South Avenue Street, Road or Ave. in the Town of Queensbury, To Construct or place a Se ti C i terati on lic 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. �. VI e-1 1. OWNERS Address is Box 265 Luzerne Rd Queensbury, NY 12804 2. CONTRACTOR or BUILDERS Name Ivan Sell cn 0 a CONTRACTOR or BUILDER'S Address � b C tb IC 4. ARCHITECT'S Name S. ARCHITECTS Address fp O r+ IIIIIIIIN 7+ 6. TYPE of Construction — (Please indicate by AC) " f 1 Wood Frame I 1 Masonry ( } Steel [ ) r+ �. O 7. PLANS and Specifications Septic Alteration to include : No- 1000 Gal , Tank with 200 ' of Tile Fields #2 Stone as per plot plan specifications and application 8_ Proposed Use r Septic Alteration $ 25 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES April 30, 19 94 (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 dare_) Dated at the Town of Queensbury thi �0th If Aril 111111­19 92 SIGNED BY ---f- CG for the Town of Queensbury Building and Z ning Inspector eL TOWN OF QUE APPLICATION FOR SEPTIC DI RMIT Permit # Fee RNI OV NSBUhe . RECEIVED Da �-,� �' �- [- . -2,. Reviewed By ������Z R LOCATION OF PROPERTY FOR INSTALLATION : 4�� I� { BLDG. g, CODE DEPT: Owner ' s Name : a ,�''� ���C fil .f�i �'+5�1 � ✓ � � ' Owner ' s Mailing Address : Installer ' s Name : 1 .e, ._ � ` Phone # : Number of bedrooms ( if residential ) : 3 Total daily flow ( residential - compute @ 150 gal . per bedroom ) : Topography-Circle One : T� Rolling Steep Slope % of Slope Soil Nature- Circle One : 1j7j5P Loam Clay Other /Depth : Ground Water-At What Depth ? 2 r�r Feet Bedrock or Impervious Material -At What Depth ? �z2e2 Feet Percolation Test- Circle One : of Require Required/Rate Min . Per Inch Domestic Water Supply-Circle One : Municipal Well Other If domestic water supply is a weFT - Separation : Water supply from any septic absorption 4 feet PROPOSED SYSTEM: Septic Tank /_c5;o�L gal . ( Minimum size : 1 , 000 gal . ) Tile Field : Each Trench ,,�:JwO feet//Total System Length �2e2o feet Seepage Pit ( s ) : Number of 4�205 Size each : ft . x ft . Size of Stone to be used : # :Z / Depth or Thickness feet HOLDING TANK SYSTEM IF REQUIRED No . of Tanks �. />I Size of Each ,Ag�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 Queensbury Sanitary Sewage Disposal Ordinance . SIGNATURE OF RESPONSIBLE PERSON : DATE : Septic System Inspections : A . All applications for septic system installation , alteration or repair , as required by the Town of Queensbury Sanitary Sewage Ordinance , shall j 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 a_ water supply 5 ) size and dimensions of all tanks , distribution boxes , tile fields and/or drywelIs B . No system shall be covered before inspection and approval by the Building Inspector . failure to comply with this requirement may result in the I 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 installation , alteration or repair of an approved system , a new proposal must be submitted to the Queensbury Building Department before further construction . 3 Town of Queensbury Building & Code Enforcement s Department 531 Bay Road Queensbury NY 12804 Remarks . l �I F �..J wn a/ Queenig"rsy BUILD6I4% G and ZONING DEPARTMENT Bay and Havifand Road, R. D. 1 Box 98 Oueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME a>'✓�'s''����� LOCAT I OyN�,(( _ �- DATE /-�- PERMIT NO. ` - +✓ `y` SOIL TYPE - Sand - Loam - Clay* - Percolation Test Required? YES - No Percolation rate - Min/Inch TYPE of SYSTEM: � Absorption field ,': total length Length of each t"nch -:5Q Depth of trenches ;' Size of gravel_ SEEPAGE P ITS#Numbe ~ of) size- ft. X _ Gravel size PIPING : Size Type Bldg . to tank �C� t{p P},p- C. Tank to list . box P yc_ Dist_ box to field / Pyt. Openings sealed? Y NO Partial LOCATION/SEPARATIONS : Foundation to tank fto �� Foundation to absorpt on ft . 1pto'�" Absorption to lot li ft . pc/4JV Separation of pits ft. LOCATION OF SYSTEM RQP TY (cirele one) Front - Rear - f side fight side - COMMENT S : (© All Y C-T1C7 r 1 SYSTEM USE APPROVED YES NO Bui ding 11fhs 9vc to 01/86 and V1 11 t au�3 Io+�D l�' m 46 lr 21� ADD