1992-139 CERTIFICATE COMPLIANCE
C TOWN OF QUEENSBURY
4 WARREN COUNTY , NEW YORK
Date
92- 139
-Mis is to certify that work requested to be done as shown by Permit No.
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been compieted.
This structure may be occupied as a
Se,]}L. __ . l t_.__ s nn
Locatiion 38 Yi ete Nreen Road
Owner Mike Graves
lot
gy Order Town Board
` TO1VN OF QUEENSBURY
Director of Bldg. cSC Cade Enforcement
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BUILDING PERMIT
TOWN) OF QUEEN'SBURY Na 92_ 139
WARREN COUNTY, NEW YORK &'
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PERMISSION is hereby granted to Mike Graves
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OWNER of property located at 38 Wintergreen Street, Road or Ave-
in the Town of Oueensbury, To Construct or piece a Septic Alteration 9n
at the above location in accordance to application together with plot plans and other information hereto filed and w
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. 4C
t, OWNER'S Address is
Same
2. CONTRACTOR or BUI LDER'S Name
Queensbury Server
3. CONTRACTOR or BUILDER 'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
F. TYPE of Construction — {Please indicate by X) fp
I I Wood Frame f ) Masonry { l Steel 11
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7. PLANS and Specifications J
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No, Septic Alteration to include; 200 ' of Tile Field using #2 Stone -fDs
10" Thickness as per plat plan specifications and application
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S. Proposed Use
Septic Alteration ,
$ 25 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES _ April 16 , ig 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 Queensburyylti':" 6th D y April 19 92
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SIGNED BY / for the Town of Queensbury
Building and ping inspector
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TOWN OF QUEENSBURIPWN OF (]UEE,NS'BUKIL
q APPLICATION FOR SEPTIC DISPOSAL PERMIT RECEIVED Permit # qt� - 1,.3 q
3 Ll A?R 13 199Z Paid 5—
Date : & GC1be'�` By
.
LOCATION OF PROPERTY FOR INSTALLATION : ! f m A ee
Owner ' s Name : '` t t s e,
Owner ' s Mailing Address : LS2 i L / r2 -4;? it
Installer ' s Name : ! :. 'LA E=
Phone :
Number of bedrooms ( i f residential ) :
Total daily flow ( residential - compute @ 150 gal . per bedroom ) : _ rtZJ
Topography- Circle One : Flat 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? Feet
Percolation Test-Circle One :C 1.t._.-!� �r � Requi red/Rate Min . Per Inch
Domestic Water Supply-Circle One : ci aX3 Well Other
If domestic water supply is a w
Separation : Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank gal . ( Minimum size : I , OOO gal . )
Tile Field : Each Trench -*"`'feet/!Total System Length feet
Seepage Pit ( s ) : Number of / Size each : ft . x ft ,
Size of Stone to be used : # / Depth or Thickness l c y feet
HOLDING TANK SYSTEM IF REQUIRED
No . of Tanks Sizelof Each Gal .
Alarms 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 . / r
SIGNATURE OF RESPONSIBLE PERSON : f`" DATE : �' 1— / �''i
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 an 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 :
flown o/ Quee►1 .5i "ry
BUILDING and ZONING DEPARTMENT
Bay a Flaviiar,d Road, R. D. Sax 98
ndaueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME_
LOCATION
DATE -- �ERMIT NIO. _
SOIL TYPE - Saner Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate Min/Inch
t
TYPE of SYSTEM:
Absorption field total sle th f�G?
Length of each t ench v ' �� C> !
Depth of trenche ✓�
Size of gravel_ k
SEEPAGE PITS-(N er ) _
Size- fto X _ t.
Gravel size
S
PIPING : iz e ( Type
Bldg . to tankX �f
Tank to disc. bo '�
Dist . box to fi d it
openings seale ES NO Partial
LOCATIONI/SEF"A TIONS
Foundation to tank `a '� ft.
Foundation t absorpt on rW2`3 ft .
Absorption lot lin 1 ft-
separation f pits - ft.
LOCATION SYSTEM ON ROPERTY (cz.rcle one)
Front - e Left si - Right side
COMMENTS : r,
9
SYSTEM USE APPROVEj'ix
NO
n Inspector
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""N OF QUEENSBUh
RECEIVED
APR 13 1992
BLDG, & CODE DMT*