1991-622 CER
TIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date .zia i¢o ,f 9' If 19
This is to certify that work requested to be done as shown by Permit No. 91®622
has been completed.
This structure may be occupied as a Sewage System
Location Northwin4s Mobile Parks:Laizer°ne Rd
Owner Daniel Drellos
By Order Town Board
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TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBURY CDNo. 91-622
WARREN COUNTY, NEW YORK w
1-1
PERMISSION is hereby granted to Northwinds Mobile Park
Luzerne Rd
OWNER of property located at Street, Road or Ave.
System
e S
in the Town of Queensbury,To Construct or place a Sewage y
at the above location in accordance to application together with plot plans and other information hereto filed and a
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OWNER'S Address is
Daniel Drellos
CD
2. CONTRACTOR or BUI LDER'S Name
Box 224 v,
GlensFalls, 8Y 12801
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3. CONTRACTOR or BUILDER'S Address fD
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to
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4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No.Sewage System to include: 1000 Gal Tank 2 seepage pits each 8' x 81
using #3 Stone, 2' Thickness as per plot plan specifications and application
8. Proposed Use
Sewage system •
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES August 30, 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 30th Day of August 19 91
SIGNED BY ,/),e76, for the Town of Queensbury
Building and Zoning Inspect
TOWN OF QUEENSBURY 1+
`JAW APPLICATIOR FOR SEPTIC DISPOSAL PERMIT
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LOCATIONLJEENSBUh. Ili
�_ OF PROPERTY FOR INSTALLATION IL)D _T(_. (A) ,I f 4f9t4'96-E9.1A11.,k_1 '
Owner' s Name' ) Pi N t l/ \r
d-� 6 BLDG.Ca. & CODE DEPT.
Address:
Installer' s Name: C�oI�- N 17-AL 5 ar.,1 Telephone: -7 /)2- - 7e)
Number of bedrooms (residential only) ✓4`,1-
Total daily flow (compute @ 150 gal per bedroom) v/n
Topography: Circle one: 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: &trrequiri:d) required
Rate - Min. Per Inch %/
Domestic water supply: Circle one: 43115Well Other
If domestic water supply is a well :
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank )0 I-/- gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of. /Size each g' feet
by feet
- Size of-stoneto be used #. - - Dep 1i or Thickness feet
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HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal .
*Alarm system and associated electrical work to be inspected by an approved
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: A_ DATE: /1" ^ ,1 P -9/
r � .
M1;�
,^Jy�3y'
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Septic System Inspections:
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A. All applieacioes 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:
I.) 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 drywalls
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 co produce said plot plan at time of inspection may
result in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installa—
tion, alteration or repair of an approved system, a new proposal must
be submitted co the Queensbury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT •
Bay and Haviland Roads
• Queensbury, New York 12804
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Remarks:
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TOWN_ on
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Bur ;, F::,4r r EPT.
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REVIEt�jLD Q 1241•
DATE
. _Awn of Queeniury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
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NAME `�Q'1/id/d,'/12tb
LOCAT I ON.41_, j ./71
DATE Xr- /5 / PERMIT NO. 9/422
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field., total le
Length of each trench
Depth of trenches\
Size of grave_ \ f
SEEPAGE PITS{Number of) ' f
Size- cr ft. X n �,ft. C l ta/ 'i-B,tf-(j-
Gravel size . '- \ /
PIPING: \Size Type
Bldg. to tank T f,i,- -Atx in.'IC_
Tank to dist. box
Dist. box to field/• ' - p- ` - - -
Openings sealed? 4110 ', NO Partial
f
LOCATION/SEPARATIONS:
Foundation to tank WA-ft.
Foundation to absorion \\,
Absorption to lot line 1 ft
Separation of pits t.
LOCATION OF SYSTENON PROPERTY(circle one)
Front Rea Left side - Right side -
COMMENTS: t1
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SYSTEM USE APPROVED , YES ' 0 \ .
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Bu ding sp ctor
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