1992-170 CERTIFICATE C►F` C+DMPLIAT`�TCE
TOWN OF QUEENSBURY
WARREN COUNTY . NEW YORK
Date /j-Q i� 2z 19
This is to certify th at work requested to be done as shown by Permit IVo. 9 �1
has been completed.
Septic Alteration
This structure may be occupied as a
1 ocation _
pwntr Robert 8 Helen Meg i tt
By Order Town Board
TC1w1V OF QUEENSOURY
pre�tor of Ild ,y 1Sc Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY 92-170 v �
WARREN COUNTY, NEW YOR K se
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PERMISSION is hereby granted to Robert & Helen Yemitt
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OWNER of property located at Box 265 Luz rile Rd, Street, Road or Ave. +�
W
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in the Town of Queensbury, To Constructor place a "Septic, Alteration
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
Same
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2, CONTRACTOR or BUI LDER'S Name e+
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Ivan Sell
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3. CONTRACTOR or BUILDERS Address �
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Do
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4. ARCHITECT'S Name 9D
5_ ARCHITECT'S Address
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6_ TYPE of Construction — (Please indicate by X)
74
( I Wood Frame ( ) Masonry ( i Steel ( 1
7. PLANS and Specifications
No. Septic Alteration to include - 126 ft of Tile Field using # stone
V Thickness as per plot plan specifications and application
8. Proposed Use
Septic Alteration
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$ 25_ QQ PERMIT FEE PAID -- THIS PERMIT EXPIRES _ April 22 . 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 date.)
1
Dater) at the Town of Queensbury t 2nd Day of A ri i 19 92
SIGNED BY for the Town of Queensbury
uiIding and Zon 1 nwector
1
TOWN
NSBURY
APPLICATION FOR SEPTIC DISPE{{��SA tfpE[F RMM TT Permit #
I oWN L7F UEEN $UFt Fee Paid
RECEIVED
Date : r
I �' APR 2 1 1992 Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION : c t
Owner ' s Name : �` ,
Owner ' s Mailing Address :
t
Installer ' s Name : � 7'1l �� r�- � � Phone # :
Number of bedrooms ( if residential ) : 4�;Z
Total daily flow ( residential - compute @ 150 gal . per bedroom ) : C ' ?
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Topography-Circle One : F a�' Rolling Steep Slope % of Slope
Soil Nature-Circle One : C5,an Loam Clay Other /Depth :
Ground Water-At What Depth ? � •- Feet
Bedrock or Impervious Material -At What Depth? �, Zy Feet
Percolation Test-Circle One : N Require Required/Rate Min . Per Inch
Domestic Water Supply-Circle One : unicipaT� Well Other
If domestic water supply is a we TT—
Separation : Water supply from any septic absorption feet
I /7
PROPOSED SYSTEM: Septic Tank Z-,�7 gal . ( Minimum size : 1 , 000 gal . )
Tile Field : Each Trench y 2, feet//Total System Length f m;Z - feet
Seepage Pit ( s ) : Number of �%' / Size each : fte x ft .
Size of Stone to be used : # '? / Depth or Thickness f feet
HOLDING TANK SYSTEM IF REQUIRED
No . of Tanks Size of Each o�' _Gal .
Alarm system and associated electrical work to be inspected by as certified
agency.
*ik*irylr ak* 1rih aklr akdlr kik sir ;
I have read the regulation on the reverse side of this sheet and agree to amide �
by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance .
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SIGNATURE OF RESPONSIBLE PERS{R! : � t� . ,/ DATE :
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Septic S stem 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 , the 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 installation ,
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 & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks :
B!-1rL[7ING jan ttr�
d ZONING DEPARTMENT
Bay and Havlland Read. R. D. T Box 9$OueensburY, New York 1280,
NAME SIE,PTI,C DISPOSAL SYSTEM INSPECTION
Lk
LcxArrav ri
DATE -L4--/C2 PERMIT NO.
SOIL TYPESand _
Require Loam - Clay
Percolation Teat
-
Percolation rate d7 YES - NO
- m1n/Inch
TYPE of SYSTEM:
Absorption field !
Length of ea h tots le th �.
trench
Depth of tre ahes
Size of gZav
SEEPAGE PITS-(
xunbe of)
Size- �-�ft. f -�--
Grave] size -�`---
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PIPING : She
B'dg - to tank Type
Tank to dist . --� ; i 4 : '(UN
Dist. box to field
OPenin
s / r�✓� �---�_
9 sea ed ? NC1
Partial
LOCATION/S ARATIONs :
Foundatio to tank
Faundatio to absoL � �LL
Absorpti to lot rPtion ft .
Se n line
of
pits
LC3CATIO OF SYSTEM ON PROP 2ZAcircle one)
Front - .Rear
CCKMEAi S : -'` s D ` Right side OLD
SYSTEM! USE APPROVED y 1
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Bum ding Ins ector
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0I/86 and vl
4ew Rea
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BLOC. & OOM DEPT"
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TOWN OF WF NS.BURY
BUILDING � CEP
P"NEWED BY
DATE