1991-238 k -„p1
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
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WARREN COUNTY, NEW YORK
Date (11,0'i,/,J . 9 19 9✓
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This is to certify that work requested to be done as shown by Permit No.
91-238
has been completed.
• This structure may be occupied as a septic alteration
Luzerne Rd
Location
GORDON PALMER
Owner
• By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. do Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No. 91-238
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to GORDON PALMER
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OWNER of property located at 258 Luzerne Road Street, Road or Ave.
in the Town of Queensbury,To Construct or 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 BUILDER'S Name r
Reliable Sewer Service
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3. CONTRACTOR or BUILDER'S Address -5
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4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) -5
CD
( ►Wood Frame ( ) Masonry ( ) Steel ( ) Q
7. PLANS and Specifications
No. Septic alteration - relocation of septic tank and addition of one
9')(8' seepage pit as per plot plan, specifications and application
8. Proposed Use
Septic system
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 25 19 93
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
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town of Queensbury before the expiration date.) -5
03
Dated at the Town of Queensbury this 25thDay of April 19 91
SIGNED BY , ''/ � ( for the Town of Queensbury
Building and Zoning Inspector
/11111111 TOWN OF UE NSBURY
# � / 3 7—// APPLICATIOn FOR T, r D. POSAL PERMIT
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DATE: -yA2 l •
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LOCATION OF PROPERTY FOR INSTALLATION S if A?,k-n,e I�
Owner's Name:
Address:
Installer' s Name:Acacjile, s��-,-a-, � � Telepho e: 72- -2-41S—
Number of bedrooms (residential only) .7 ,5
Total daily flow (compute @ 150 gal per bedroom) S O
Topography: Circle one: Flat . Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand Loam Clay Other /Depth:
Ground Water: At what depth? Feet TOWN OF Q EENSBUR .
PECEIVFD
. Bedrock or Impervious Material : At what depth? Feet
Percolation test: Circle one: not required required . APR 24 1991
Rate - Min. Per Inch DLDG. A CODE DEPT.
Domestic water supply.: Circle one: Municipal Well Other
If domestic water supply is a. wel .
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
7Wir
SEEPAGE PIT(S): Number of /Size each 9 feet
-by feet
Size of stone to be used#.. 3 /Depth or Thickness l feet
************ ***************
HOLDING TANK SYSTE " I IRED
O. of Tanks Size o aci Gal .
*AlarpL, and associated electri.:c-a , to be inspec r- , by an approved
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:, r(
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011
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•
Septic System Lnspeccions:
•
A. All applications for septic system installation, alteration or repair,
as required by the Town of Queensbury Sanitary Sewage Ordinance, shall
be. submicced to the building Department at least 24 hours before start
of construction and shall include a plot plan shoving:
1.) the proposed location of the system
2.) location and distance to lac lines
3.) location and distance -to structures
4.) location and distance co any water supply
5.) size and dimensions of all ranks, distribution boxes,
- rile fields anal/or drywalls
B. Nu system shall be covered before inspection and approval by the
building Inspuctor. Failure to comply with this requirement may
ru5ulc in the uncovering of the system by the installer and a fine
of up co $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 may
rusuhc in an immediate work stoppage.
D., Should unforeseen problems during construction prevent proper inscalla
cion, alteration or rup:iir. of an approved system, a new proposal must
bu submitted co the Quuunsbury Building Department before further
construction. •
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
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.` awn oQ ueenLbur . . l9. /��
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
•
SEP IC DISPOSAL SYSTEM INSPECTION
NAME \ceN Gjq- (5--)
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LOCATION aS 4 .)-07, tie e C
DATE Lf / 0 PERMIT NO. 9 / — 3()
SOIL TYPE - '. )• - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate : Min/Inch .1
t
TYPE of SYSTEM:
Absorption field, total length
Length of each trench: /
Depth of trenches \ • /
Size of gravel \ /•
SEEPAGE P ITS-fNumber of) \a /7 u Fp //- 9 u g
Size- ft. X ft. \;, /
Gravel size , 451. 3,1--5/ ,
PIPING: Size' Type
Bldg. to tank / ., 'C .
Tank to dist. box y l/
Dist. box to field/.'t �, tl
Openings sealed? 400 NO \ Partial
LOCATION/SEPARATIONS: Qe�eze /`g;„
Foundation to tank 3 a f .
Foundation to absorption 3e) ft?.a .
Absorption to lot link c,3o ft .i,
Separation of pits 020 ft.
LOCATION OF SYST u e. - 40PERTY(cir'cle one)
Front - Rear Left side - Right side -
COMMENTS: 1 },;t
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SYSTEM USE APPROVED
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Building Inspector
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TOWN OF QUEERISBLIN't
RECEIVED
APR 24 1991
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BLDG. & CODE DEPT.
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