1991-612 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
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WARREN COUNTY, NEW YORK
y Date 4/ja . ,I;') 19 9/
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is to certify that work requested to be done as shown by Permit No.
has been completed.
This structure may be occupied as a Septic Alteration
Location 7 Haven Lane
Owner Sandra Parker
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-512
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Sandra Parker
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OWNER of property located at 7 Haven Lane Street,Road or Ave.
in the Town of Queensbury,To Construct or place a Septic alteration F '
at the above location in accordance to application together with plot plans and other information hereto filed and IV
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
Same
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2. CONTRACTOR or BUILDER'S Name
Steven Sanders
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3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
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( 1 Wood Frame ( ) Masonry ( )Steel ( )
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7. PLANS and Specifications
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No. Septic alteration to include: 1000 Gal Tank w/200' of Tile Field -f%
using #2 Stone, 1' Thickness as per plot plan specifications and application
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8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES AUGUST 27, 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 27t Day f August 19_ 9],_
SIGNED BY i for the Town of Queensbury
Building and Zoning Iri'sector
TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # 47-6'7L2,
edFee P____, ,, ko.aid
!Date: G qr Reviewed B c E,/
LOCATION OF PROPERTY FOR INSTALLATION: 7 /1/4 veil AUG 216 1991
Owner' s Name: SGl yiC rc PQM'M- z°r F I_nr. & CODE nEPT.
Owner's Mailing Address: 7 , *iv -'
Installer' s Name: Sbozi ✓I S? N1/�ys Phone #: 793 2/Jd
Number of bedrooms (if residential ) : 3
Total daily flow (residential-compute @ 150 gal . per bedroom): `/�O
Topography-Circle One: lat Rolling Steep Slope % of Slope
Soil Nature-Circle One: 41100 Loam Clay Other /Depth:
Ground Water-At What Depth? 1 Feet
Bedrock or Impervious Material-At What Depth? • Feet
Percolation Test-Circle One: Not Required >equired/Rate Min. Per Inch
Domestic Water Supply-Circle One: (MAnicip 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 . )
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Tile Field: Each Trench W feet//Total System LengthcO feet
Seepage Pit(s) : Number of / Size each: ft. x ft.
Size of Stone to be used: # / Depth or Thickness T 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 Q eensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: r
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:
'4C4 Pill ..
awn ot, Q/ueenstur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D.-1 Bois 98
Queensbury, New York 12801
SEP IC DISPOSAL SYSTEM INSPECTION
NAME er YJ1 '(Cv .
,
LOCATION \ACWPJY\
DATE. ( /36 PERMIT NO. 9 /— (pi �
SOIL TYPE 4110M - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch 1
TYPE of SYSTEM: -
Absorption field, total. length ) ,
Length of each trend U - /
Depth of trenches " 4 '
Size of gravel 'It. . _
SEEPAGE PITS4Numbe of) •
Size.- ft. X ft.
Gravel size
PIPING: Side re
Bldg. to tank a di G
Tank to dist. box 41 "' pvc.
Dist. box to field/p.'t ,/-/ '`. PV(J
Openings sealed? .YS. NO Partial
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LOCATION/SEPARATIONS•
Foundation to tank / /a ft.
Foundation to absorptio pc)ft.
Absorption to lot Dine , _p_y, ft.
Separation of pit ' 6ft.
LOCATION SYST ON PRO ERTY(circle one)
Front - e -` Left side - Right side -
COMMENTS:
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SYSTEM USE APPROVE NO
Bui ing Ins ctor•
01/86 and vl
I OWN OF OUEENSiGh,
RECEIVED
AUG 2 6 1991
BLDG. & CODE DEPT.
14 -
7 7 7
I I
TOWN OF QUEENSBURY
BUILDING & C e!"'' S DEPT%
REVIEWED B
(\ D DATE
FILE COPY
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