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1991-571 CERTIFICATE OF COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date / ./, r",42/- /919 !L This is to certify that work requested to be done as shown by Permit No. 91-571 has been completed. This structure may be occupied as a Septic. Al teratinn Location Rte 9 Lake George Rd Owner Graycourt Motel/ Mrs., Amoia By Order Town Board TOWN OF QUEENSBURY Zefg, r)/ Director of Bldg. & Code Enforcement BUILDING PERMIT X TOWN OF QUEENSBURY No. 91-571 WARREN COUNTY, NEW YORK w PERMISSION is hereby granted to Gray Court Motel OWNER of property located at Rte 9 Street,Road or Ave. in the Town of Queensbury,To Construct or place a Septic Al terati on 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 Same -ems 0 2. CONTRACTOR or BUILDER'S Name Brian Granger 3. CONTRACTOR or BUILDER'S Address 70 e+ O 4. ARCHITECT'S Name CD 5. ARCHITECT'S Address CD N 6. TYPE of Construction—(Please indicate by X) O ( )Wood Frame ( 1 Masonry ( I Steel ( ) 7. PLANS and Specifications No. Septic alterations to include specifications as per Engineered Drawings 8. Proposed Use • Septic Alterations $ 35.00 PERMIT FEE PAID —THIS PERMIT EXPIRES August 13, 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 13th Da f > August 19 91 SIGNED BY /)�� / for the Town of Queensbury Building and Zoning I spector ``, j TOWN OF QUEENSBURY APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # la_Et --6-7/ ' Fee Paid 5,61) Date: Ak..74* ( Reviewed LOCATION OF PROPERTY FOR INSTALLATION: ( -.1- l5 CA,ed..)-cea A,�AN A9 IZg0c7i Owner' s Name: a�a,� I/Vi.7*�� Ibtn• ytq®ii Owner' s Mailing Address: (Z.+ ( ast_12 -S 'bc (\ IJ14J. tz okoc2 Installer' s Name: (-6,,,t.„,A (:).vc,Lv e �67tS-4' Phone #: 7 7Z- crt,/77 Number of bedrooms (i f residential ) : y�f s.` „vt �-+rX Total daily flow (residential-compute @ 150 gal . per bedroom) : �L1 '`'' ' ' ' 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 well - Separation: Water supply from any septic absorption feet 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 th's sheet and agree to abide by these and all requirements of the own of Queens Ty Sanitary Sewage Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON: DATE: ll ai 4i/ 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: _Jown of Queeniur , /Da4 BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME •Ail ' , C 6011- LOCATIONS/ 9 1 DATE i/`7' / W PERMIT NO. 9/— 7/ SOIL TYPE - Sa - 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 PITS4Nuinbe of) Size- ' ft. X ft. Gravel size I "i �I PIPING: Size i` Type Bldg. to tank Tank to dist. box Dist. box to field/pit Openings sealed? YES NO Partial LOCATION/SEPARATIONS: Foundation to tank j ft. ' Foundation to absorption f6 ft. Absorption to'lotline -- ft. Separation of pits (( ft. LOCATION OF SYSTEM ON?PROPERTY(circle one) Front - RearRight side - COMMENTS: ;yr - ///iv-ni • SYSTEM USE APPROVED NO Build ' 4 Inspecto 01/86 and vl ROUTE 9 7 SITE PLAN SCALE: I"= 20' . a AtL a SCALE: NONE AA t Mum AM: oesign flow rate. x ©rt4" by awm4m p4wcalati4m Mate 3- .1 "sorption a> ram'+ .221-mod 1WAlk 3 102 x oaed, ,a�st t 4m rate. ,lift*" � 3iep �A .. (1Yf.. Dia.. wv Y F � �rL ' Required xoptia w o:, 1,* go w 4 F R25)- 3" #010.1 "k,111w_:tloo Aroa is seed by town water x it is reported tt -are; ems. by ,itkdiwiaaioio�l. k devices tat - fwwttm AM4 6- 60 Itttee, . l+ FILE COPY -TOWN OF QUEEMSBURY BUILDIN Q®S DEPT. REVIEWED B DATE 3 Norte �. FILE'topy C oun y Engineering t RA Gww FANG X f la" DIVA* 6101, As noW, DOE ••'L • •R Kss 'w