1992-148 �LM1M 7
CERTIFICATE CJF COMPLIANI16
TOWN OF QUEENSSURY
WARREN COUNTY , NEW YORK
Date_ f I ' 1 Lea 19 ^2-•
3 4 * !^tea 1 V%ba Li 7L"Z10
requested to be done as shown by Permit No.
This is to certify that work
has been completed.
Al
'I'Mis structure may be occupied as a
I ocatian 54 Helen Drive
JoAnn A Peter Daly
Owner
By Order Town Board
TOWN c)F QUEENSBURY
�Jy �
Director of Bldg. be Code 'Enforcement
BUiLDING PERMIT
TOWN OF QUEENSBURY �
Na. 92- 148
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to JoAnn Dal fy
OWNER of property located at 54 Helen DRi ye 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
Sale
2_ CONTRACTOR or BUl LOERS Name
Condon ' s Septic A Drain Service
3. CONTRACTOR or BUILDER'S Address
4_ ARCHITECT'S Name
5. ARCHtTECT'S Address
6. TYPE of Construction — (Please indicate by X)
( ) Wood Frame 1 ) Masonry ( I Steel I I
7. PLANS and Specifications
No. Septic Alteration to include : 2 seepage pits each 8 ' x 8 ' using
#3 stone , 1 ' Thickness as per plot plan specifications
B. Proposed Use
Septic Alteration
$ 25 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES April 15, 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 Oueensbu ry before the expiration date_)
Dated at the Town of Queensbury this 15th Clay of April 19 92
SIGNED BY .� �' n,� s �- for the Town of Queensbury
Building and Zoning I nspe
07v - q �-
TOWN OFM&EL-N$MJRy C�_.__...
RPPLICATION FOR SEPTi �e y" Per Fee mPaid /7 C ci"b
AP u
Date : {� - /4/ - � �-- � �� ig�z eviewed By
LOCATION OF PROPERTY FOR INSTALLATION :BU_.110 "(:iv7*,P- 'Dlwix;� .
Owner ' s Name : e i 0%
Owner ' s Mailing Address :
{_
Installer ' s Name : jf7 'c � s Phone # : 5
Number of bedrooms ( if residential ) : -�
Total daily flow ( residential - compute @ 150 _gal , per bedroom ) : S C�
Topography- Circle One : Flat Rolling Steep Slope % of Slope
Soil Nature- Circle One : Sand Loam Clay Other /Depth :
Ground Water-At What Depth ? ZA Feet
Bedrock or Impervious Material -At What Depth ? 66 Feet
Percolation Test- Circle One : C6Lot Required Required/ Rate Min . Per Inch
Domestic Water Supply- Circle One : Municipal Well Other _
If domestic water supply is a we
Separation : Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank e.6 ( SI ( 'r,'' gal . ( Minimum size : 1 , 000 gal . )
Tile Field : Each Trench feet//Total System Length feet
p.
Seepage Pit ( s ) : Number of Size each : ft , x ft .
Size of Stone to be . used : # / Depth or Thickness _ '� feet
HOLDING TANK SYSTEM IF REQUIRED
No . of Tanks Size of 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 PERSONO � CI�C ,' PaF DATE :
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 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 a�n��d�� 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 .
Co 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 :
/o lflir! of
BUILDING and ZONING DEPARTME
Bay and Haviland Road, R.0. 1 Sox 98
oueensbury, New ''fork 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
LOCATION D
DATE .Z - PERMIT NO.
SCIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - I3C3
Percolation rate - Min/Inch
TYPE of SYSTEMS fatal length
Absorption field .
Length of each trench
Depth of trenches
size of gravel.�
SEEPAGE PITS-*Ntunbe of
Size- 5'� ft. X
Gravel size _ Siz Type
PIPING : � r
Bldg . to tank �i '
Tank to dist . box ' -
_Pv
Dist . box to field/ NO Partial
Openings sealed?
LOCATION/SEPARNTIONS
i
Foundation to tank i I 4/ f t.
Foundation to absor i n - ZC' ft .Y
ft1-
Absorption to lot 1 ne • �C1�
separat
ion of pits .._.�-
2- ft :
ION OF SYS dN PROPERTY (circle one)
- Rear - Le side - Right side -
NTS :
SYSTEM USE APPROVED YE
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y
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