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1992-219 f f Md CERTIFICATE C)►F COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK 1 Date / .+/r?ra f� 19 I This is to Certify that work rtqueated to be done as shown by Permit No. 92- 219 I� ` has been completed. S T11is structure may be occupied as a _ Sieptic Alteration tcD �3 Lumene Road on I Owner _ Gary Ben- ---- I By Order Town Board TOWN OF QUEENSBUlky i Director of Bldg. dC Code Enforcement I w x BUILDING PERMIT if TOWN OF +QUEENSBURY � No. 92-219 t✓ WARREN COUNTY, NEW YORK l eh PERMISSION is hereby granted to Gary Ben_ MdY OWNER of property located at 1 IJZ me Rd Street, Road or Ave. in the Town of Queensbury, To Construct or place a _ sic tiC Al tern 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_ Oo f_ OWNER'S Address is m Z �rC �r 2- CONTRACTOR or BUILDERS Name � Condon ' s Septic A Drain 3. CONTRACTOR or BUILDER'S Address C rM a 4_ ARCHITECT'S Name M S_ ARCHITECT'S Address VY M -v r� B_ TYPE of Construction — (Please indicate by X) 310 e— ( ) Wood Frame I } Masonry 1 S Steel 1 7. PLANS and Specifications No. Septic Alteration to include: 2 seepage pits each 8' x 8 ' using #3 stone , 2 ' thickness as per plot plan specifications and application S. Proposed Use Septic Alteration $ 25 .00 PERMIT FEE PAID --- THIS PERMIT EXPIRES May 11 111994 IIf 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 thi ay f 1992 SIGNED 8Y ` for the Town of Queensbury uilding and Zonl4iel nspector ILI TOWN OF QUEENSBURY APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # .' - l oW11 Fee OF0646 1 Date : Reviewed By MY LOCATION OF PROPERTY FOR INSTALLATION : - u 2 .2rIvE /Z Owner ' s 'Name : ( / _ � ? $ � - 3� S�DG. &, CODE ©"'C- - Owner ' s Mailing Address : UZ- F fk &.1es ID __� Installer ' s Name : (f0VV ! (2A0 S SEoO=4r `c. 4a: > I �V Phone # : Number of bedrooms ( if residential ) : 3 Total daily flow ( residential - compute @ 150 gal . per bedroom ) : y�U Topography- Circle One : F1at Rolling Steep Slope % of Slope Soil Nature- Circle One : Sand Loam Clay Other /Depth : Ground Water-At What Depth ? ,l'xf 4 Feet Bedrock or Impervious Material - At What Depth ? Feet Percolation Test- Circle One : (N Required equiredd Required/Rate Min . Per Inch Domestic Water Supply- Circle One : M�'niPo Well Other If domestic water supply is a well - Separation : Water supply from any septic absorption feet 1600 4L S e'y _t 1A ' PROPOSED SYSTEM: Septic Tank gal . ( Minimum size : 1 , 000 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 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 : �c tX ��iyQ�_ � �. DATE :. 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 aa_n_� water supply 5 ) size and dimensions of alf tanks , distribution boxes , tile fields and/or drywalls Be 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 : 11 �] 0&v "a EPASTMENT ,30jLo1T1G a" Z4f1113G �lRoad, R o 1 Box 9aIs BaV and Hayiland sew pueenshurY� Neer York i2SGi pTIC DISPOSAL SYSTEM INSPEC-LION SE NPME : 7 LpCAT ION f pEWIT No Loam _ Clay s,yp _ sa fixed? YES SOIL. Test Rem snoh percolation Min/ percolation rate * YiyE o£ SYSTVKs l len tic+n leld a rate , -Ler%Pbs t Of each tr ex� C pth Of tr+enC el Size o gITS4L3viex o ,y SEEPAGE pp- £ Size-- � 79. YPe Gravel Size ize lJ p SF 1-13G P. anK t--f Bldg - to" t X ho *�anK to ais,t- 17i to enin9 sseaL lec3 O J4. TxoNIsEpA?J%TTONS : � t .P ( r' A ► Eoun� aieion � apsorPticn ft. goundatian to lot linet- P,bs,orPtlon cle one) OpE {c 5�CAT 4 SYSTEM CO p g tit Side Front gear Left Si CCNTS - SY STEV4 T3 SE AP P RCY4'p'L� Yss 14O .o� gui cuing ns ec'tor 01/86 mz1 vl u/ow►t ea/ Queenshurl �. bUILOING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAMEr LOCATION DATE f PERMIT NO . SOIL TYPE - Sand - Loam - Clay Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption f ieldr total length Length of each trench Depth of trenches ' Size of gravel T SEEPAGE PITs4Number of) _ Size- ft. X Gravel size PIPING : size Type Bldgo to tank Tank to list . box Dist . box to field/pit openings sealed? YES NO Partial LOCATION/SEPARATICNS : Foundation to tank ft. Foundation to absorption ft . Absorption to lot line ft . Separation of pits ft- LOCATION OFF SYSTEM ON PROPERTY (Cirele one) Front - Rear - Left side - Right side - CCHMENTS : � C 04 SYSTEM USE APPR ELk YES NO Building inspector 01/86 and vl �Aky DENWAY Cov>,v ) s'yrLc q� j�,4e400 sue. LuZ € AQ R j5 7f - �63 � tl� � � - 7?if- &ryL Ld zi` 4 ID �x IV 3 �5-�. Im U �'onru-off• 0 �KtS-rr �� o 0 3 93A TOM OF QUEENSBURYai MUM; COD DEPT. � 2z BU o T REVIEWED BY p � MATE . .� 1/�Z� v a j m � � G Lvz. Z ,q