1991-823 JO/
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
• Date th,-/eiriizt 19
This'is to certify that work requested to be done as shown by Permit No. 91-823
has been completed.
This structure may be occupied as a Septic Alteration
"oration 19 Lupine Lane
Owner David & Theresa Middleton
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
. _
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-823
WARREN COUNTY, NEW YORK •
0
PERMISSION is hereby granted to David & Theresa Middleton
OWNER of property located at 19 Lupine Lane Street, Road or Ave. 'I
in the Town of Queensbury,To Construct or place a Septic Alteration 'A
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
2. CONTRACTOR or BUILDER'S Name fD
Richard Lee & Son °
a
3. CONTRACTOR or BUILDER'S Address
mis
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4. ARCHITECT'S Name
N
5. ARCHITECT'S Address
1.0
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6. TYPE of Construction—(Please indicate by X)
fD
( )Wood Frame ( ) Masonry ( )Steel ( ) r
CD
7. PLANS and Specifications
No. Septic Alteration to include: 200' of Tile Field using #2 stone
1' Thickness as per plot plan specifications and application v,
8. Proposed Use
Septic alteration
$ 25.00 PERMITFEE PAID —THIS PERMIT EXPIRES November 21, 19 93
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the 0
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this _21.st Day of November 19 91
SIGNED BY for the Town of Queensbury
Building and Zonii g Inspector
/1► l I I .1" 14 .ovVN ®F OUEENSb .
`J_ RECEIVED
R TOWN OF QUEENSBURY PP ICATION FOR SEPTIC DISPOSAL PERfIITv 2 0 1991Permit # %
Fee P ��yy/—r5
aid
ELDG. & CODE DEPT.
Date: / % Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: / ' ���.-✓� L,9.✓� �� -•A✓f( zSo((
Owner' s Name: --- ,a1//z. %z,Z/s 4 /.di)z 2605
Owner's Mailing Address: /Y L-' "-✓1 /i I_
Installer' s Name: 2c4;.- (/ 1,1e Job Phone #:
Number of bedrooms (if residential ): 3 `:3�,>,zoo 6u S
Total daily flow (residential-compute @ 150 gal . per bedroom) : Kc-O �4 -
Topography-Circle One: Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay. Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? /1,10 A/4— Feet
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Munic' Well Other e4✓
If domestic water supply is a -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank j�, 1/19 gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length K, C°--'2affeet
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 PERSON: ( ����f� ti % DATE: ///0 /
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 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:
•
Jotun o/ Queen3burcy .
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSSAL SYSTEM INSPECTION
NAME ,,i�4l 1\r\ r)o t fY\
LOCAT ION 4� IF-V (�l. �. C- LCL'}NL1
DATE ii / a PERMIT NO. C' ( - 3
SOIL TYPE -4ma'+ - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length ,2c,2, .
Length of each trench 5,6
Depth of trenches d '
Size of ravel
g tea-- �
SEEPAGE PITS4Number• of) /
- -Size- ft. X ft. /
Gravel size ,
PIPING: I Size/ Type
Bldg. to tank 1
Tank to dist. box
Dist. box to field/ '..� y U 5-40'
Openings sealed? d NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ViSift.
Foundation to absorpttonf/pp" ft.
Absorption to lot line\I /aft.
Separation of pits 1 ft.
LOCATION OF YSTEM ON FAOPERTY(circle one)
Front ear - Left s'de - Right side -
COMME :
S;Ccc (rz4.2 1
04711-7/
10
SYSTEM USE .APPROVED
Buildi g Inspector •
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