1991-271 •
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f. CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Pia y 20 19 91
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This is to certify tha work r uestetto be done as shown by Permit No. 91-271
has been completed.
This structure may be occupied as a Septic Alteration
Location 26 Lad dinner Lane
Owner John Coral s ti
By Order Town Board
TOWN OF QUEENSBURY
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Director of Bldg. do Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBURY "
No. 91-271
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Goral ski, John o
OWNER of property located at 26 Ladysl i pper Lane 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. O
1. OWNER'S Address is H
Same pr
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2. CONTRACTOR or BUILDER'S Name
Condon's Septic
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3. CONTRACTOR or BUILDER'S Address a'
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address N
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6. TYPE of Construction—(Please indicate by X)
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( )Wood Frame ( ) Masonry ( )Steel ( ) - w
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7. PLANS and Specifications 0
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No. Septic Alteration to include: 250' of tile field using #2 Stone
1' Thickness
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 7, 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 this .Da of may 19 9i
SIGNED BY -.:2{// 1,T ) for the Town of Queensbury
Building and Zo i'ng Inspector
TO AN . QUEENSBURY i '
APPLICATIOHAPic ., , ERMIT ' �;
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DATE: ' f/ a `' ; 'AWeo
LOCATION OF PROPERTY FOR INSTALLATION �- a4Y site,-
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EeLg gqING CODE'
Owner's Name: O / K -- J 0
Address: G aciy Sit,odoeA J 'am)
Installer' s Name:C®n)c/j/v s �� �L L Telephone: [5 4-42-
Number of bedrooms (residential only) 3
Total daily flow (compute @ 150 gal per bedroom) V5 0
Topography: Circle one: 41, Rolling Steep Slope % of Slope
Soil Nature: Circle one: CVO Loam Clay Other ./Depth:
Ground Water: At what depth? 1�j/ Feet
Bedrock or Impervious Material : At what depth? 'U//il Feet
Percolation test: Circle one: not required required
Rate - Min. Per Inch
Domestic water supply: Circle .one: nicipal Well Other
If domestic water supply is a well :
Separation: Water supply from any septic absorption feet.
DO CAL ey c
PROPOSED SYSTEM: Septic Tank gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench SC) feet/Total system length 2- 5-0 feet
SEEPAGE. PIT(S): Number of /Size each feet
by feet
Size of stone to be. used #. 7i /Depth or Thickness /` feet
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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: ��
1
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Se.ti0 s stem Inspections:
A. All applications for septic system installation, alteration or repair,
as required by the Town of Queensbury Sanitary Sewage Ordinance, shall
bee submiccad to..the Building Department at least 24 hour* before start
of construction'and shall include a plot plan shoving:
1.) the proposed location of cho sysc.e■
2.) location and distance co 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 drywalls
B. Nu system shall be covered before inspection and approval by the -
Building Inspuctor. Failure to comply with this requirement may
rasulc in the uncovering of the system by the installer and a fine
cif up co $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure co produce said plot plan at time of inspection may
result in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installs— •
cion, alteration or rupuir of an approved system, a new proposal must
bu submitted co the Queensbury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT •
Bay and Haviland Roads
Queensbury, New York 12804
Ramarks:
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J'vwn o/ Queniturj . /90
J UILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801 • .
SEPTIC DISPOSAL SYSTEM INSPECTION •
NAME G7-r '-&si NC)11!'1 .
LOCAT ION -9 Cn ..__e:d,5 I tepy 0LGvvts—
DATE .9 / c% RMIT NOOII` ) I
.4111
SOIL TYPE Loam - Clay
Percolatio -st Required? YES,' - NO,
Percolation rate - Min/Inch " ,F`di
TYPE of SYSTEM:
Absorption field, total length
Length of each trench ,Ti:%/ if'
Depth of trenches ' j Y
Size of gravel A L. ,p .1
SEEPAGE PITS*Number of) I •
Size- ft. X - ft./ iI .
Gravel size , / 1
PIPING: Sri e Type
Bldg. to tank <d .
Tank to dist. box �� ./42L
Dist. box to field/pil; y't P/C-_
Openings sealed? ES' NO Partial
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LOCATION/SEPARATIONS+p
41 .IS .
Foundation to tank I ?� ft.
Foundation to abso,pti on 3 5 ft.
Absorption to lot in?e Lot ft.
Separation of pit • ft.
LOCATION OF SYST ONPROPERTY(circle one)
Front - ar - L ft side - Right side -
COMMENTS:
AdMik
SYSTEM USE APPROV411/1001 / /
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