1992-203 x
CERTIFICIATE %-Xv CC►1VIPLIA.�'�T+CE
TOWN OF QUE'ENSSURY
WARREN COUNTY, NEW YORK
19 q.Z
LA IIIIIIIIIIkc
requested, to be dent as shown by Permit No.
This is to certify that work
has been completed-
This structure may be occupied as a
Se tic Alteration
Clark Street
pw,ner Peter & P
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
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BUILDING PERMIT ".
TOWN OF QUEENSBURY Na. 92-203 0
WARREN COUNTY, NEW YORK �
1
PERMISSION is hereby granted to Peter 8 PanayGota Olsen nNs
OWNER of property located at 9 Clark Street Street, Road or Ave.
G
in the Town of Queensbury, To Construct or place a S$ pti c Alteration In
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_
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t . OWNER'S Address is
Same
2. CONTRACTOR or BUILDERS Name W
Signorelli & Son Inc _
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3. CONTRACTOR or BUILDER'S Address
iI7
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4. ARCHITECT'S Name
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5_ ARCHITECT'S Address
6. TYPE of Construction — (please indicate by X) f
{ ) Wood Frame ( I Masonry ( 1 Steel ( }
7_ PLANS and Specifications
No, Septic Alteration to include : 2 seepage pits each 8 ' x8 ' using #3 stone
2 ' thickness as per plot plan specifications and application
8. Proposed Use
Septic Alteration
$ PERMIT FEE PAID — THIS PERMIT EXPIRES May 5 _
(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 Day o May i9___92
SIGNED BY for the Town of Queensbury
Building and Zonlh4j nspector
TOWNrQEB --
APPLICATION FOR SEPTL ITPermit # �Fee Paid= dr�
40
Date : 3 ` r SZ�t. Reviewed By 's3. 1
LOCATION OF PROPERTY FOR INSTALLATION : ? Ly4e
Owner ' s Name : : 6 & ti
owner ' s Mailing Address : "
Installer ' s Name : poi) rrz'/ C Phone # : '�
t
Number of bedrooms ( if residential ) : 3
Total daily flow ( residential - compute @ 150 gal , per bedroom ) :
Topography- Circle One : Flat Rolling Steep Slope % of Slope
Soil Nature- Circle One Sand D Loam Clay Other /Depth :
Ground Water-At What Depth? Feet
Bedrock or Impervious Material -At What Depth ? Feet
Percolation Test- Circle One :(' N to Required�_ Re eired/ Rate Min . Per Inch
Domestic Water Supply- Circle One & Munici a J Well Other
If domestic water supply is a -
Separation : Water supply from any septic absorption feet
PROPOSED SYSTEM: t+c Tank' �xs� 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 : # _� f Depth or Thickness ,;R!%0rfi '
HOLDING TANK SYSTEM IF REQUIRED
No . of Tanks Sizelof Each Gal .
Alarm system and associated electrical work to be inspected y 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 .
� 4
SIGNATURE OF RESPONSIBLE PERSON : DATE :
�
�
S40tf*c . 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 supp"iy
5 ) size and dimensions of all tanks , distribution boxes , tile fields
and/or drywells
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 .
Co 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 :
cc�arr I LC (,,J'[ L___
�.Jotcrra! o �ueens�ur�
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME / r{ j
LOCATION
DATE ^ l� -#'ERM I T NO
SOIL TYPE - SRest.
- Loam - Clay -_
Percolation(
ercolation T Required? YES 4
Percolation rate - Min/Inch
TYPE of SYSTEM :
Absorption field , total. le
Length of each trench
Depth of trenches
Size of gravel
SEEPAGE PITS4Number of) y
Size- ft. X £t.
Gravel size
PIPING : S ze Type
Sang . to tank
Tank to dirt . box ij� CL,—
Dist. box to field/p " ,lo J
Openings sealed? S 0 Partial
LOCATION/SEPARATI S :
Foundation to t I_�j YA1' C
Foundation to ab Porpt! t ^ -�
Absorption to 1 t line 2� ft et-W s
Separation of its 2� / £t. P
LC7CATIOI3 F S TEM ON P OPERTY (circle one)
Front Rea Left sid - Right side -
CCHISC dTS
XL-
b(uv.i -r-t aA/
SYSTEM USE APPROVED fENO
Building Ins ctcir
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01/8+6 and vl
' .Down 0/ Qaeenshecr� PM ,
BUILDING and ZONING DEPARTIAENT
Bay and Haviland Road, R.D. 1 Sox 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
OW
NAME U"► "
LOCATION CO( /�,
DATEf PERMIT NO . l.f
SOIL 'TYPE - Sand - Loam - Clay
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field , total leng#fh---"
Length of each trench
Depth of trench
Size of gra
SEEPAGE PITS{Numbe of
Size- ft. X _ ft .
Gravel size
PIPING : Size Type
Bldg . to tank {
Tank to dirt. box
Dist* box to field it
Openings sealed? YES NO Partial
LOCATION/SEPARATI
Foundation to tan ft.
Foundation t[� ab r tion ft .
Absorption to to 1 e ft.
Separation of p s ft.
LOCATION OF SYS PROPERTY (circle one)
Front - Rear - ft ' de - Right side -
CCNMENTS
Ec� Le v z EP 6s Pors ,P�r
C,cf /4 Aj
SYSTEM USE APPROVED YES NO
N Bu ld ing Insp ctor
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awn o/ Queen 3 u r y / `z�z"`"�'
BUILDING and ZONING DEPARTME117
Say and Haviland Road, R. D. 1 Sox 9
Oueensbury, New York 12801
SEPTIC DISSPPOfSAL SYSTEM INSPECTION
NAME ,c/' / r
LOC,AT I ON (�. -�X�'Z �
DATE -5 / $ERMIT NO . .!
SOIL TYPE - 'Sand - Loam - Clay
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field , total lenc4kh
Length of each trenc
Depth of trenches '
Size of gravel_
SEEPAGE PITS4Nuimber f)
Size- fte X t.
Gravel size
PIPING : Size Type
Bldg _ to tank
Tank. to disc _ box
gisto box to fief /pit
Openings sealed? YES NO Partial
LOCATION/SEPA TIONS :
Foundation to tank ft.
Foundation t absorption ft .
Absorption o lot line ft_
Separation of pits ft_
LOCATION SYSTEM ON PROPE TY (eircle one)
Front - R ar Left side - Aight side -
CCMMENTS :{
SYSTEM USE APPROVED YES NO
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Building In for
01/86 and vl
I�wlm►. � ��.
r
TO OF El°qdI .SBURY
BUILDING & C ,i DEPT.
REVIEWED BY s
DATE 3r