1991-217 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date if 19 fZ
� r
This is to certify that work requested to be done as shown by Permit No. 91-217
has been completed. _
This structure may be occupied as a Septic Alteration
Location Luzerne Rd
Owner North winds Mobile Park/ Daniel SI George lr&&1 nc
By Order Town Board
TOWN OF QUEENSBURY
r
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-217 w
WARREN COUNTY, NEW YORK cu
0
PERMISSION is hereby granted to Northwinds Mobile Park
w
OWNER of property located at Luzerne Rd Street, Road or Ave. to
k0
in the Town of Queensbury,To Construct or place a Septic Al tPrati on Lot 72 & 73
at the above location in accordance to application together with plot plans and other information hereto filed and 0
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. s
1. OWNER'S Address is
O.
Daniel & George Drellos In
0
2. CONTRACTOR or BUILDER'S Name —+
rD
Sanitary Sewer .n
a
3. CONTRACTOR or BUILDER'S Address
rD
e+
4. ARCHITECT'S Name �^
C+
fD
0
1.
5. ARCHITECT'S Address 0
6. TYPE of Construction— (Please indicate by X)
( 1 Wood Frame ( ) Masonry ( ) Steel ( )
7. PLANS and Specifications ••
No. Septic Alteration to include 1000 gal tank ti/2- seepage pits each 8' x
8' with #3 Stone, 2' thickness
8. Proposed Use
Septic System
$ 25.00 PERMIT FEE PAID—THIS PERMIT EXPIRES April 18, 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 thi 18th Day of April 19 91
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
N
,bi7 7.2- I- 73 TOWN OF QU ENSBURY < / `P 7 1
� }iC j APPLICATIOU FOR
Est
DATE: / ` /9- 90//
LOCATION OF PR RTY FOR INSTALLATION It .2 l
d( .,C,i .vX C iO�i/e t ��
Owner's Name: f H-/t// G -76 ,�.�.c_ C�/6�4',-
P. )
U Address: / ) 0 7? v ZZ e 6 /—
r
Installer's Name ,v ►;A„� � c.)�/ Telephone: `7�r"'� — 7 �.5^'7
,
Number of bedrooms (residential only) ,/vl
Total daily flow (compute @ 150 gal per bedroom) P/7)-
Topography: Circle one• Fla Rolling Steep Slope % of Slope
Soil Nature: Circle- one; .:nd Loam Clay Other- -� /Depth:
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what depth? TOWN OFpe ENS ud `�r
th �"j's'du( � C �ra�
�� l k
Percolation test: Circle one: require require '?; I � � '
l'r - li ji
Rate - Min. Per Inch 6°'-'\ APR 181991 . ,
Domestic water supply: Circle one: nicip Well Othgtw illt4 . a rflfF nFPT.
If domestic water supply is a, wel
Separation: Water supply from any septic absorption . feet.
PROPOSED SYSTEM: Septic Tank I D D, gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length - feet
SEEPA PIT(S): Number of 2— /Size each S3 feet
by feet
--- Size of stone to-be-used-IV -;-Depth-.or-Thickness -- --;?===--- -- ---- feet-- - -
(� eQK_ *******.************.********
SOL ill I rr c- �LA,Qr 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: V DATE: I/:' / 3'-- 61 //
1
•
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 scare
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 to any water supply
5.) size and dimensions of all tanks, distribution boxes,
tile fields and/or drywalls
B. Nu system shall be covered before inspection and approval by the
Building Inspuctor. Failure to comply with this requirement may
rgsulc in the uncovering of the system by the installer and a fine
of u to f250.:0
pr0. :.
C. An: `.approved copy ,of: t,he plot plan shall be available on the construction
site Failure co produce said plot plan at time of inspection may
r.isult;.anv an` immrdisc`e. work stoppage.
D. Should :unfores..n..problams during construction prevent proper installa-
cion, alcaracion or repair of an approved system, a new proposal must
be submitted co the Queansbury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
•
Remarks:
•
•
•
•
4 •
_loran o/ Queeniurj
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
t
NAME �.CK�
LOCATION '7 1
DATE Y)� /6?,/ PERMIT NO.
SOIL TYPE Loam - Clay -
Percolation Test Required? YES• - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench '
Depth of trenches '
Size of gravel
SEEPAGE PITS{Number of) •
Size- ft. X ft.
Gravel size
PIPING: Size p
Bldg. to tank `t `j IC •
Tank to dist. box \ l/ C
Dist. box to field/pit 5/ 11 (C
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS: t •
Foundation to tank ' Oft.
Foundation to absorption \'akOft.
Absorption to lot line I ft.
Separation of pits j 10. ft.
LOCATION OF SYSTEM ON PiROPERTY(circle one)
Front -(Regis - Left side - Right side -
COMMENTS:
2,01 f;442 •
- PX 511-fr el •
•
•
SYSTEM USE APPROVES NO
B ding In ector •
01/86 and vl
.. ,
...
. .
.,..
, . o
. E a
...
e .
. . _ .
. I
. .
5 .... ..— .... I, —I 1 illt X I .
..., .
I.. 4
• `11 ..r— — — — — ,
, • .
, .
= .--. . ,-_. : :,-..., 7—• t: r. •o 1 iik T , .