1991-213 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY-
WARREN COUNTY, NEW YORK
Date /9A1,G/ .2919 9'i
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This is to certify that work requested to be done as shown by Permit No. 91-213
has been completed.
This structure may be occupied as a Septic Al ter ati on
I nation 20 Sy1 van
Owner Paul Cedar
'By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY x
No. 91-213
WARREN COUNTY, NEW YORK
0
PERMISSION is hereby granted to Paul Cedarstrnm v
OWNER of property located at 20 Sylvan Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Septic Alteration O
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
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2. CONTRACTOR or BUILDER'S Name 'S
Queensbury Sewer
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) a
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( )Wood Frame ( I Masonry ( )Steel ( ) C
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7. PLANS and Specifications
No Septic alteration to include: 2 seepage pits each 8' x8' with #3
Stone, 2' thickness
8. Proposed Use
SEPTIC ALTERATION
$ 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 this 18th Day of April 19 91
i 11
SIGNED BY c % % for the Town of Queensbury
Building and Zoning j%nspector
/ � TOWN OF QU NSBURY
`1,0 APPLICATION FOR S OSAL PER iuvvMU. of
RECEIVED L►R�
DATE: is- -
LOCATION OF PROPERTY FOR INSTALLATION 1k7.1991 1
BLDG.Owner's Nam �� � ;, � �� �L � ��` 4L7;f & CODE DBp7',
Address: �5 z. c c 1 i' ,4- i
Installer' s Name: <� «l
(- ' „Lie-/- Telephone: //-'�-f( (4(
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) L/
Topography: Circle one: 411111 Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sa Loam Clay Other /Depth:
Ground Water: At what depth? Feet
Bedrock or Impervious Material :. At what depth? Feet
Percolation test: Circle one: r ._required) required
Rate - Min. Per Inch
Domestic water supply: Circle one: (Municipal) Well Other
If domestic water supply is a, well :
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE . PIT(S): Number `�of /Size each J feet
by 5( feet
Size of stone to be used #. ') /Depth or Thickness 2_ 1 feet
*****************************
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.-
Ir.
I have read the reg°al.ation on the reverse side of this shtei zi a egret: tc abide
by,:these and all requirements of the Town of Queensbury Sanitary Sewage Disposai.
Ordinance.
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SIGNATURE OF RESPONSIBLE PERSON: 4TE. - 1 /j
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•
1
•
•
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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 co 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 co any water supply
. 5.) size and dimensions of all tanks, distribution boxes,
cil, fields and/or drywalls
B. Nu system shall be covered before inspection and approval by the
Iuilding Inspector. Failure to comply with this requirement may
result in the uncovering of the system by the installer and a fine
ut up to $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure co produce said plot plan at time of inspection say
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
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
•
•
Remarks:
•
•
•
awn o/ Queenitury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEEPPTTIIC /DISPOSAL SYSTEM INSPECTION
NAME / ma(/ eai S'i'
LOCATION 3 j/ y
DATE_ �///CO PERMIT NO. ®///' 0213
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SOIL TYPE - -Sa - Loam - Cla/ -
Percolation Test Required? /YES - NO/7
Percolation rate - Min/Inc f " / ,'
TYPE of SYSTEM:
Absorption field, total ength
Length of each trench
Depth of trenches ' ,/ •
Size of gravel_ / / _
SEEPAGE PITS{Number ol)
Size- 3 ft. X 8 fit.
Gravel size
PIPING: ize Type
Bldg. to tank
Tank to dist. box Li /D v C
Dist. box to field/ it Y ./
Openings sealed? YES NO Partial
LOCATION/SEPARAT ONS: c /
Foundation to t - k G K/ r ft.
Foundation to 'sorption p o ft.
Absorption to dt line /5 ft.
Separation of pits /5 ft.
LOCATION OF YSTEM ON PROPERTY(circle one)
Front Rea Left side - Right side -
COMMENT :
..771/4:1_,Aj("It.e....e_
SYSTEM USE APPROVE A.O
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B w lding Insp- tor
01/86 and vl
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TOWN OF QUEENSBU '• . • I
RECEIVED
APR 17 1991
BLDG. & CODE DEFT.
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