1991-218 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date ,!`.f1if,/./, 19 19/
This is to certify that work requested to be done as shown by Permit No. 91-218
has been completed.
This structure may be occupied as a S nti i etl ca RG
Location •
Ltizeme Road
Owner Daniel & George Drel 1 os
By Order Town Board
TOWN OF QUEENSBURY
109.0(;./ V14-7.-4-2(..
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY y:
No. 91-218
WARREN COUNTY, NEW YORK •�
0
PERMISSION is hereby granted to Daniel & George Drellos / NORTHWINDS MOBILE PARK (.4
n)
OWNER of property located at Luzerne Rd Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Septic Alteration Lot # 54 &55
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.
1. OWNER'S Address is O
Same `*
a
2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer
CT
CD
3. CONTRACTOR or BUILDER'S Address
PO Box 224 -1
Glens Falls, NY 'r
4. ARCHITECT'S Name
C-,
5. ARCHITECT'S Address CD
n
IL
6. TYPE of Construction— (Please indicate by X) e+
CD
( )Wood Frame ( ) Masonry ( )Steel ( 1 - -
O
O
7. PLANS and Specifications
Septic Alteration to include:
No. 1000 gal Tank with 2 seepage pits each 8' x 8' with #3 Stone, 2'
thickness
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 18, 1993
(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 18th Day of April 19 91
SIGNED BY c / `�'�` v;rL/ for the Town of Queensbury
Building and Zoning1nspector
02111 -Fr TOWN OF EENSBURY q/-a/ g 1
:# ;�1 �j�f APPLICATION FO D SAL PERMIT
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/U -- 9/ yy
LOCATION OF PROPERTY FOR INSTALLATION 1 OIt C\Cv iav/r N°6/(<- ` /L.1 L.
r
Owner's Name: 1��1/EL $- ed( /or
Address:e--p
O /_? ° .)-V ( ' F
l
Installer's Name: �� 17 -n . ,/��,R,` Telephone: 7 9,2-- 7,,.2,5`7
Number of bedrooms (residential only) N/A-
Total daily flow (compute @ 150 gal per bedroom) Al A
Topography: Circle one: lat Rolling Steep Slope % of Slope
Soil Nature: Circle one: and Loam Clay Other /Depth:
Ground Water: At what depth? : --- Feet
TOWN OF C ENSI irk i
Bedrock or Impervious Material : At what depth? c--- c-� Fe `o _ 3+--..
Percolation 'test: Circle one: not required required w ' ' -f ' i 4
,q,j.:1,,,,,,,
Rate - Min. Per Inch APR 18 7999
Domestic water supply: Circle one: unicipai) Well OtherL3UILDlNG & CODE DEPT.
If domestic water supply is a. well:
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank /cY a 0 gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of 'Z /Size each feet
by feet
Size of stone to be used #.. 3- - - /Depth or Thickness _ - feet
/1cS p
Zit( - *****************************
uhAi i r e7 ep LAAJS- 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: DATE: /V--# 1//
Sceptic 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 co structures
4.) location and distance co any water supply
5.) size and dimensions of all tanks, distribution boxes,
tile fields and/or drywalls
B. No system shall be covered before inspection and approval by the
Building Inspuctor. Failure to comply with this requirement may
r6:suit4n .the:uncov.rinb of the system by the installer and a fine
uf....up, .to.
C. An,':approved dopy. offhe plot plan shall be available on the construction
ita. e.Failur _to 'produce said plot plan at time of inspection may
result in' an `immediace work stoppage.
D. 'Should unfo"reseen.'problems during construction prevent proper installa—
tion, 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 and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
hzmarks:
•
•
awn 01 Queeniturj
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC�/ DISPOSAL SYSTEM INSPECTION
NAME '7/Q' -l/✓.(/li'A
LOCATION 41 54 7` _,5:5—
DATE 1// %6/7 PERMIT NO. g�- /,/7
SOIL TYPE and - 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 PITS4Nuinber of)
Size- 4 ft. X r ft. .4- a 'Di. S——
Gravel size pr.
PIPING: Size Type
Bldg. to tank
Tank to dist. box a, a`,' J� e/C
Dist. box to fiel• • ti y
Openings sealed? NO Partial
LOCATION/SEPARATIONSid�
Foundation to tank
Foundation to absorption _ /ft. //./
Absorption to lot4>'line / ft. /"
Separation of pit's ft.
LOCATION OF SYSTEM ON PR PEr,RTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS: tt
l ka/e/G ' �'/�l�sl 1��1P e
1-4a 516(
SYSTEM USE APPROVED YES NO
Buildin4' Inspector
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