1991-280 t
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date '-ii9/494,_ /0 19
3 03 (40- (1'
This is to certify that work requested to be done as shown by Permit No. 91 280
has been completed.
This structure may be, u ied as a Sentir Alter Linn
1 1' G, Dix Avenue
Location' _ ..�.
Lawrence El Margaret Naito
Owner. _
By Order Town Board
TOWN OF QUEENSBURY
e <,y
Director of Bldg. & Code Enforcement
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• BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-280
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Lawrence & Margaret Waite
OWNER of property located at 118 Lower Dix Avenue 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 w.
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. fDD
1. OWNER'S Address is
Rte #2 Box 5917
Notre Dame St Ext.
Hudson FAlls, NY 12839
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2. CONTRACTOR or BUILDER'S Name gto
Sanitary Sewer
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name r-
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5. ARCHITECT'S Address K
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6. TYPE of Construction—(Please indicate by X)
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( 1 Wood Frame ( I Masonry ( )Steel ( ) n
7. PLANS and Specifications eF
No. Septic alteration to include: 1000 gal tank with200' of Tile Field r
. using #2 Stone, 1' Thickness
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 8, 19 93
(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 th._ 8th Da ,of
May 19 91
I �
SIGNED BY , for the Town of Queensbury
Building and Zbng Inspector
��• TOWN OF QUEE S URY l
.:APPLICATION FOR SEPTIC DI P
sI
DATE: 7- 9
LOCATION OF PROPERTY FOR INSTALLATION I f L oc v . .. o_ut b 199:1
Owner' s Name: tu jr9tice vie ; Gu T : Lb( . c CODE DEP
Address: I- BOA 59 i -1 0 r „P S -
Installer' s Name:./ A N iTA,,.y (I A/ Telephone: 79,)
Number of bedrooms (residential only) 2—
Total daily flow (compute @ 150 gal per bedroom) J a O
Topography: Circle one: 400 Rolling Steep Slope % of Slope
Soil Nature: Circle one:. Loam Clay Other /Depth:
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what depth? Feet
Percolation test Circle one:2) not required required
Rate - Min. Per Inch
Domestic water supply: Circle one: unicipal) Well Other
If domestic water supply is a well :
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank l b o( gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench 5 D feet/Total system length ,2 o n feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used #.. 2- /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 an approved
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: 7 - (l
!vCiC System Inspeccions:
•
A. All applications for septic system installation, alteration or repair,
as required by the Town of Queensbury Sanitary Sewage Ordinance, shall
be subaiccad co 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 co structures
4.) location and distance co any water supply
5.) size and dimensions of all__tanks, distribut.ion. boxes,
tile fields and/or drywalls
B. Nu system shall be covered before inspection and approval by the
Building Inspuccor. Failure to comply with this requirement may
ruault in the uncovering of cha 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 to produce said plot plan ac cilia of inspection say
rusulc in an immediace work stoppage.
D. Should unforeseen problems during construction prevent proper installa-
tion, alteration or repair of an approved system, a new proposal must
bu submitted co cha Queensbury Building Department before further
couscruccion.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
kumarks:
•
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pit.•'
_loom 01 Queeni1ur/lly2,2
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D.. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME 4 I4/,f kgfc.i ` 'j 9 ciJJ— )/L�
LOCATION lir X,mt.
DATE, 51 /./ PERMIT NO. 91-216
SOIL TYPE - Sand' - Loam - Clay -
Percolation Test Required? . YES - NO
Percolation rate - Min/Inch
4,,
TYPE of SYSTEM: •
`
Absorption field, total length C7
Length of each trench ' p ''
Depth of trenches . Z-3:'f7. . I
Size of gravel' ..'7-- „ ,"
SEEPAGE P er .4'
Siz ft. ft. i
avel s' ,i 01'
PIPING: Size ir T. pe
Bldg. to tank j`f ,f /9/j ---
Tank to dist. box if, f p(/L
Dist. box 'to field/pit ''z Arc,-
Openings sealed? TO? O Partial
LOCATION/SEPARATIONS: ,qj
Foundation to tank /�ft.
Foundation to absorpt -on`. fif
Absorption to lot lit ----ft O1L'
Separation of' pits N /-07 .ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - ear - Left/ side fight si e
COMMENTS: /
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SYSTEM USE APPROVED II1P
NO
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