1991-491 • • s\\- ' -• ' -., • • __..„
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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
. pl. 19 q j
Date
This is to certify that work requested to be done as shown by Permit No. 91-491
has, been completed.
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This structure may be occupied as a Septic Alteration
Location Lower Marren Street
Owner Jeff's Place/Marvan & Susan Kozak
By Order Town Board
TOWN OF QUEENSBURY
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Director of Bldg. & Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-491
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Jeff's Place •w
OWNER of property located at Lower Warren Street Street, Road or Ave. -P
IV
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 -h
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
127 Cronin Rd
Queensbury, NY 12804
2. CONTRACTOR or BUILDER'S Name
'S
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name L9
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. Septic Alteration to include: 2 seepage pits each 8' x 4' using
#3 Stone, 2+' Thickness
8. Proposed Use
Septic Alteration
$ 35.00 PERMIT_FEE PAID —THIS PERMIT EXPIRES July 10, 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 thi 10th Day of ' July 19 91
SIGNED BY / v for the Town of Queensbury
uilding and Zoni Inspector
9/-10/
Tovol
i m / ' TOWN OF QUEENSBU'App
APPLICATION FOR SEPTIC DISPOSAL PE'w , Permit # 9/—4/9/
44,00: 1 9 4991 Fee Paid Jar'
Date: %L®a & CObt, Bevilewed By
LOCATION OF PROPERTY FOR INSTALLATION: :ref: pities- , -6y�gv7 1,11�Rp�11/4J 57 .
Owner' s Name: i1/ Gri 2 . s Le,5,4 /C07/9./‹.". `)1 �f3q ;
Owner's Mailing Address:
Installer' s Name: K;n CGS Phone #:
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom) :
Topography-Circle One: Flat Rolling Steep Slope % of Slope
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 Well Other _
If domestic water supply is a
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank67X,ST,04gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s) : Number of /�/p / Size each: �` ft., x ft.
Size of Stone to be used: # . / Depth or Thickness 2 +`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: 'DATE: r9 7/f F/7/
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:
awn %th
_Down of Queeniburcy /1
BUL,P,1W't and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME AJ -4f Pe c
LOCATION ,(26/1.-( 14 'i» / - ,
DATE OW 9/ PERMIT NO. 9/-419/
SOIL TYPE - Sand - Loam - Clay, -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches ' .
Size of gravel J="
SEEPAGE PITS{Number of) /
Size- k ft. X /2) ft.?
Gravel size 0'2_
PIPING: Size T' e
Bldg. to tank . I.c,/ " .1uII/C.
Tank to dist. box ;y'' S/ " ." pits
Dist. box to field/pit 9 4 c 'Opt
Openings sealed? YE NO Partial
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LOCATION/SEPARATIONSci
Foundation to tank I, ft.
' Foundation to absorption _ ft.
. Absorption to'lot line" ft.
Separation of pits i/ ft.
LOCATION OF SYSTEM 9N PROPERTY(circle one)
Front - Rear - Leftr:'side - Right side -
COMMENTS: k' „r
t
I
f
SYSTEM US APPROVED ® NO
Buil ' g Inspect
01/86 and vl
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clown of Qs4eeni Ur/
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801 .
SEPTIC DISPOSAL YSTEM INSPECTION
NAME LOCAT91-p
L (/' A.(4
��
DATE 7/1/ 9/ PERMIT N0: f/—419J
SOIL TYPE San - Loam •= Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench;'
Depth of trenches '
Size of gravel .
SEEPAGE PITS{Number of) j
Size- 61 ft. X 1 ft.
Gravel size
PIPING: t Size' Type
Bld to tank
Tank to dist. box ;•t
Dist. box to field%pit `'y 1/
Openings sealed? 'YES NO Partial
LOCATION/SEPARATIONS;c
Foundation to tank ft. .
_
' Foundation to absorption ft.
. Absorption to lot£line 5'ft.
Separation of pits ft.
LOCATION OF SYSTEM ;ON PROPERTY(circ one)
Front - Rear - Left' side - ight side
COMMENTS: '' u
i
1 p,),40.r ;i ,e.. .„4, ,. /D
V
rr.
1 _Af.Yier-e2' .
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SYSTEM SE APPROVED YES NO
Bui ing Inspe or
01/86 and vl
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awn, o/ Queen i/ ur,
BUILDING and ZONING DEPARTMENT. .
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
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SEPTIC DISPOSAL SYSTEM INSPECTION
NAME ,.� `-c"S 23a v/
LOCATION
DATE 2 /(,.; PERMIT NO. /l-4 q/
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches i
Size of gravel ! .
SEEPAGE PITS{Number of) f
Size- ft. X ft.
Gravel size\
PIPING: S ze Type
Bldg. to tank
Tank to dist. bo /
Dist. box to field/pith'
Openings sealed? YES NO Partial
LOCATION/SEFARATIONS:
Foundation to tank /\ ft.
Foundation to absorpti ft. '
Absorption to lot line ft.
Separation of pits \ ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - &ft side . Right side -
COMMENTS:
�/� t�7pill 7 � A 102r2friled.
'4,74 Cyr
SYSTEM USE .APPROVED YES NO
Bu' ding Inspl ctor
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APPROVED
FOR SEWAGE DISPOSAL
VA'
ORK STATE DEPARTMENT OF HEALTH
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' • SANITARY ENGINEER
V JUL..O 9 1O 1
DATE , r
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