1992-163 N % A
1
s! V
CERTIFICATE
of cOMPLIA�NCE
i
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date_! — 19 �
Th{ toCerr,fy that woikregUeated to be done as shown by Ptrmit No. 92�163
has been completed.
This structure may be occupied as a
Septic Alteration
{ L oca'LiZS Knoll Rd .
i 0wner Francis A Nancy McKeon
By Order Town Board
TOWN OF +QUEE,4$ URY
t
Director of Bldg. & +Code Enforcement
a
BUILDING PERMIT K
TOWN OF QUEENSBURY
No. 92-163 0
WARREN COUNTY, NEW YOR K ro
at
PERMISSION is hereby granted to . Francis A Nancy McKeon '
OWNER of property located at Knolls Rd North Street, Road or Ave. e'Jrf
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. 3
t. OWNER"S Address is
Same �
'n
2_ CONTRACTOR or 8UI LEER'S Name
t"1
Hometown Sewer `"
as
x
3. CONTRACTOR or BUILDER'S Address
f7
4. ARCHITECT'S Name
c
co
5. ARCHITECT'S Address
1/1
:fa
CS.
O
6_ TYPE of Construction — (Please indicate by X)
( I Wood Frame l ) Masonry ( I Steel I I
T_ PLANS and Specifications CA
Septic Alteration to include : 330 ft of Tile Field using #2 Stone MO
2 ' Thickness as per plot plan specifications and application �.
8_ Proposed Use
r
Septic Alteration
$ 25*00 PERMIT FEE PAID — THIS PERMIT EXPIRES April 21 . 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.]
Dated at the Town of Queensbury this 21st D of ' A r 19 92_
SIGNED BY G ' for the Town of Queensbury
d Z Building anoni nspector
OF
%"WAPPLICATION FOR TSEPk"V1R UEENSBURY IT Permit # �
��� UH 4 Fee Paid c7v
RECEIVED
Date : ,� ;d APR 2 U 1992 Reviewed By
LOCATION OF PROPERTY FOR INSTALLAT�- • +
Owner ' s Name : ��.,� `c ar►t . J AA 5ii
Owner ' s Mailing Address :
Installer ' s Name . _IZ2 Leec m ra Phone # : ^;� 3 - ys 3
Number of bedrooms ( if residential ) : t�z
Total daily flow ( residential - compute @ 150 gal . per bedroom ) :
Topography-Circle One : Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One : Sand Loam C1a Other /depth :
Ground Water-At What Depth ? Feet
Bedrock or Impervious Material -At What Depth ? r41 _.v2f Feet
Percolation Test-Circle One : Not Required Required/ Rate -Min . Per Inch
Domestic Water Supply-Circle One : Municipal el Other
If domestic water supply is a well -
Separation % 'Water supply from 2py septic absorption � feet
PROPOSED SYSTEM: Septic Tank gal . ( Minimum size : 000 gal . )
Tile Field : Each Trench feet//Total System Length feet
Seepage Pit ( s ) : Number of / Size each : fte x ft .
Size of Stone to be used : # / Depth or Thickness feet
HOLDING TANK SYSTEM IF REQUIRED
No . of Tanks Sizelof Each Gal .
Alarm system and associated electrical work to be inspected by a certified
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
Septic System Inspections :
A . A17 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 , tile 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 :
auras o/ MeendI urn
BOILDING and ZONING DEPARTMENT
Bay and Hauiland 'Road. R.D. 1 Box 98
Queensbury. New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
LOCAT I CIN �` � + (�es1
DATE to PERMIT
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption Meld , total length �-
Length of each trench ---�
TSepth of trenches
Size of gravel
SEEPAGE PITS$3us+ber of] ... -
Size- ft. X - ft.
Gravel size
PIPING : S e TYpe
Bldg . to tank
jTank to dist. box — -
Dist. box to field,/'pit
ppenings sealed? YES NC) Partial
LpCATION/SEPARAT3:ONS : ft.
Foundation to tank ft .
Foundation to absorb On
ft.
Absorption to lot 1i a ft.
Separation of pits
T�DCATIC7N C7F SYSTEM PRO RTY (circle one)
Front
- Rear - Le side Right side -
caw E TS : - iL-- TC+
7C
1 r Y Ir r
SYSTEM i3SE APPROV
ED YES NO
I _
s
Sui cling Ins ector
jol/86 and vl
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
41 STATE STREET, ALBANY, NEW YORK 12207
Applicatio=ftMffgdPd
I #nilpare qIII .,I
THISr CERTIFIES THAT
only the electrical equipment ae deeeribed bolas and introduced by ow the above apgpPlication number in the prerniasi of
�Y N TMl I4'AT� � fd E i N v 'H . LY��' wwy.
l%AW4 Section Black Las
_ in thefo,llataing location vent ❑ ]at Fl. Ll 2nd Fl.
s Laaa examined an and fuund to be in compliance with the requireavents of this Board.
1!
URE RXTURES RANGES COIOiKItrfO DICKS OVENS DISH WASHE
FI%T
RS EXHAUST TANS
r TURE ECEPTACLES SWITCHES INCANbESCEw F wE PT.
LUOSCEMT OTHER A K. W. APT- K. W. APT. K.W. AMT. K. W. AMT. H. P.
x
DRYER'S FURNACE MOTORS ftWURE APPLIANCE V t 21 SPECIAL RECPT TIME CLOCKS EEII IltiviT "NAMES WET"MTM DUAMOM
SYSTEMS wALr. WAM
♦ APT. K. W. OIL H- P. GAS H. P- APT. NR]. A. W. G. AMT. AMP. APT_ AMPS. TRANS. APT. H. P. no. OP PEST
+1
SERVICE DISCOAW IECT No. Of S E R VAk" I C E
APT. AMP- F1"PE EliI/N. T .+E' nM L N 9W S .I 9W 3 X 4W ' �ER�.C.+DIJD. Cf CC C H8. 4P HbLtG Di MI kEG No. OF NEUTRALS OF wM• G.
OTHER APPARATUS;
I Se�pttco
I31 „i �'§{iSy iiiJ i.
• �' � `v E:N [i.li . BRANCH AIANIAf3ER
Per.
This certificate must not be altered in any monner; return to the office of the Board if incorrect_ Inspectors nI be identified by their credentials.
# COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
BUILDING and ZONING DEPARTMENT ox
Bay and Hauifand Road.
98
Oueensbury. New York 12801
�' r �
SEPTIC DISPOSAL SYSTEM INSPECTION
NME-
LOCAT I ON > t ' /6
DATE '+�n`a PERMIT NCI .
SOIL 'TYPE - sand - Loam - 8 N0
Cla �-�-
Percolation Test �quire;(?n/Inch
Percolation rate -
TYPE of SYSTEM:
Absorption field , total length
5" .
Length of each trench
Depth of trenches �
Size of grave],
SEEPAGE PITS#Number ftL
Size- -
Gravel size Si a Type
p;PING :
Bldg . to tank
Tank to dirtw box s ,
Dist- box to 'field+° NO Partial
Cypenings sealed?
LOCAT ION/sEPARAVION S : f t.
Foundation to tank �ft.
Foundation to absorin o p €t .
Absorption to lot lirt a ft*
separation of pit$ PROP .TY (circle one)
LOCATION STEXIde - R ht side
Front - Rear - Left
ICY loee�
i
SYSTEM LISE APPROVED YES No
Y
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