1991-626 -' ter.-. :.�.-, .. ,, a'.;"`�:-. -. .._ .'{�"r.:..v -":a�+:k•r�n.,+.� .., _�, -+ ., _ r' ,.-,.. - .•a.,ii,:i.-T• � .. .. -
r . CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date s dawi,.a. ,579
This is to certify that work requested to be done as shown by Permit No. 91 626
has been completed.
This structure may be occupied as a Septic Alteration
Location 13 Westmore Avenue
Owner James Nelson
• By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. dt Code Enforcement
BUILDING PERMIT
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TOWN OF QUEENSBURY
No. 91-626
WARREN COUNTY, NEW YORK cc
cn
PERMISSION is hereby granted to James Nelson
OWNER of property located at 13 Westmore Avenue Street, Road or Ave.
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 fD
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. C
Y
1. OWNER'S Address is
Same
CD
to
2. CONTRACTOR or BUILDER'S Name
Ivan Bell
3. CONTRACTOR or BUILDER'S Address f�D
Cl,
O
fD
4. ARCHITECT'S Name
fD
0
fD
5. ARCHITECT'S Address
fD
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6. TYPE of Construction—(Please indicate by X) _+
I—
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( )Wood Frame ( ) Masonry ( )Steel ( ) - fD
7. PLANS and Specifications O
Septic alteration to include: 200' of Tile Field using #2 Stone
as per plot plan specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES September 19 1993
(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 1st,- Day of September 19 91
SIGNED BY ( / 41. ) for the Town of Queensbury
Building and Zoning Insp4for
114j TOWN OF QUEENSBURY (�
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # 1 il— (p
.Fee Paid 5, cr0
Date: 5/J 5 / Reviewed By
TOW' .fl vii-ti.� �s<:;
L...�•n ti.i 4,, _.
LOCATION OF PROPERTY FOR INSTALLATION: /..Y h/ ,r! 0 '-'101''W �``�ki0
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Owner' s Name: Cri'v. �t.i..j-e7/ ' L,j;
L Si:= ' 191
�. y
Owner' s Mailing Address: jj W-,. _5;f"'fry 0),..L 1,.<
Installer's Name: j/ Phone ���®��� & 7(1 DE DEPT.
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom) : y.5'O
Topography-Circle One: irr, Rolling Steep Slope % of Slope
Soil Nature-Circle One: faT Loam Clay - Other /Depth:
Ground Water-At What Depth? 4/ 0 Feet
Bedrock or Impervious Material-At What Depth? —y Feet
Percolation Test-Circle One: Not Required Required/Rate 01.7 Min. Per Inch
Domestic Water Supply-Circle One: 'MunicipaDi Well Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption 17,9 feet
eSTPROPOSED SYSTEM: Septic /dU 8 gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench ,, O feet//Total System Length A o 0 feet
Seepage Pit(s) : Number of ,J t9 / Size each: ft., x ft.
Size of Stone to be used: # 2 / Depth or Thickness feet
**************
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks 27,1 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: j-- C DATE: X/q F/
/ / /
R E V IZVVE.D BY �I' 4A- `fez/
DATE 9/ /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 tq 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:
Arr-
vi < Pi'Y\
e',C own o/ Queenilury.
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
•
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME \�� , G v c '�
LOCATION I 3 we S 1p-r.e_
DATE L' PERMIT NO.
SOIL TYPE �- Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length adeu
Length of each trench 56 '
Depth of trenches -3-Sl
Size of gravel" # 2
SEEPAGE PITS{Number of) •
Size- ft. X ft.
Gravel size
PIPING: Size
Bldg. to tank 1, 4L
Tank to dist. box\ eit
Dist. box to field pit �L ". / fl//
Openings sealed? YES NO Partial
\r�
LOCATION/SEPARATIONS: `,
Foundation to tank fs1 ft.
Foundation to absorption . ft.
Absorption to lot line \30 ft.
Separation of pits ‘4, ft.
LOCATION OF SYSTEM ON PROP RTY(circle one)
•
Front -!tb - Left side - Right side -
COMMENTS:
't.
SYSTEM USE APPROVED NO
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Bu ding Ins ector
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