1991-366 1
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date (2e/./✓J.O_ rs 1/19 1/
This is to certify that work requested to be done as shown by Permit No. 91a366
has been completed.
This structure may be occupied as a Septic Alteration
Location RD#4 Box 379 Pro nel l o Rd
Owner Yvonne Goedert
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Co Enforcement
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BUILDING PERMIT
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TOWN OF QUEENSBURY
No. 91-366
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Yvonne Goedertcri
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OWNER of property located at RD#4 Box 379 Pi nel l o Rd Street, Road or Ave.
I in the Town of Queensbury,To Construct or place a Septic Alteration 0-1
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
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2. CONTRACTOR or BUILDER'S Name
Mike Walker
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) O
( I Wood Frame ( ) Masonry ( )Steel ( ) _ __
7. PLANS and Specifications
No.Septic alteration to include: 125' Tile Field
8. Proposed Use
Septic Alteration
$ 25_00 PERMIT FEE PAID—THIS PERMIT EXPIRES May 31, 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 31st Day of - May 1991
SIGNED BY C .!i% for the Town of Queensbury
Building and Zoni Inspector
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A U RMO OUEENSBUF1Y
� � TOWN OF Q
APPLICATION FOR SEPTIC DISPOSALREECNIMED Permit # Q( 3�6
Fee Paid s2
MAY 291991
Date: .S - a9—9! , & CO E ®EPTReviewed By
LOCATION OF PROPERTY FOR INSTALLAT IN: � ��
Owner' s Name: 2-6-1242e \LI, ,l Ws—5605
dr Owner' s Mailing A ess: )j41 337q P,&1,1. /5f
Installer' s Name: ;Kt, /J 'aJ2ir - Phone #: 6 5"Crl7 3K
Number of bedrooms (if residential ) : t:R,
Total daily flow (residential-compute @ 150 gal . per bedroom) :
Topography-Circle One: Flat Rolling Steep Slope % of Slope V1/141"
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: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal - Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption —75-- feet
PROPOSED SYSTEM: Septic Tank E�x�2gal . (Minimum size: 1,000 gal . )
/Tile Field: Each Trench � - feet//Total System Length (2 6 feet jj
Seepage Pit(s) : Number of / Size each: ft. x ft.
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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.
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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� C�
SIGNATURE OF RESPONSIBLE PERSON: ' DATE: .��a ( I 1
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:
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• _Jouin of Queeniur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98 .
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTIONI�
NAME LjvLm J . 10-6-C�(�1Lk.1
LOCATION & ,�j'7I P(Mi.et ed
DATE jai PERMIT NO. q1-5fp1n
SOIL TYPE -•- Loam - Clay - /
Percolation est Required? YES + NO
Percolation rate - Min/Inch +' /
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TYPE of SYSTEM: i j
Absorption field, total length /.G
Length of each trench F'6- /
Depth of trenches -::? ' '
Size of gravel ,44
SEEPAGE PITS{Number of) 1
Size- ft. X ft. U
Gravel size
PIPING: Size (.;Type .
e3
Bldg. to tank 15/-
Tank to dist. box £/a , ,ae/e
Dist. box to field/pit Ie /' 4 +c
Openings sealed? 6q NO 'partial
LOCATION/SEPARATIONS. d/ i
Foundation to tank tK'Ar fit.
Foundation to absorptioniS p ft.
. Absorption to lot line f ft.
Separation 'of pits / ft.
LOCATIONGQIySYSTEM ON PROPERTY(circle one)
Front L - Left si1de - Right,! side -
COMMENTS: �f`y ,,.
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SYSTEM USE APPROVE YES NO
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Building Inspector
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TOWN OF QUEENS[ UM
d RECEIVED
— - MAY 3 0-1991 — — • T
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BLDG. & C DE DEPT.
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