1991-662 `� ..✓ '�
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Art,011- a 19 e(
This is to certify that work requested to be done as shown by Permit No. 91-662
has been completed.
This structure may be occupied as a Septic Alteration
Location 22 Sherwood Drive
Andrew aaluse
Owner
By Order Town Board
TOWN OF QUEENSBURY
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Director of Bldg. do Code,Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-662 0
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Andrew Jause
OWNER of property located at 22 Sherwood Drive 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
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OWNER'S Address is CID
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2. CONTRACTOR or BUILDER'S Name
Ivan Bell
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address I
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6. TYPE of Construction—(Please indicate by X) 'p
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( )Wood Frame ( ) Masonry ( ) Steel ( )
7. PLANS and Specifications r1)
No.Septic Alteration to include: 200' of tile field using #2 stone
with 1' THickness 0
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES September 18, 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 18t Day of SEPTEMBER 1991
SIGNED BY for the Town of Queensbury
Building and Zoning Iriector
AMML
TOWN OF QUEENSBURY ir /�
APPLICATION FOR SEPTIC DISPOSAL PERMIT �' Permit.# //r4__.
Fee Pa -
Date: ,S-iefil /4 5%/ Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: 2 SLi-c.v,Qvt,eIDv A4 j
Owner' s Name: Ay,dittte :re,
Owner' s Mailing Address: 2 Shti1, 1,,A2oot. ,9y, (9i )/
Installer' s Name: [l!G �, c../ J Phone #: ?9',ROEU
Number of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 gal . per bedroom) : 4 SO
Topography-Circle One: lat Rolling Steep Slope % of Slope
Soil Nature-Circle One: C' •1 Loam Clay Other /Depth:
Ground Water-At What Depth? $" Feet
i.. Bedrock or Impervious Material-At What Depth? 00 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 ,
y/ cgal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench 019 feet//Total System Length p v feet
' Seepage Pit(s) : Number of 727/ / Size each: ft. x — ft.
Size of Stone to be used: # / Depth or Thickness "a feet
-Ft(it TANK SYSTE IRQ�f IREB
_ No. o a�-/ Size of al .
Alarm system an ed electrical wor inspected by a e
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: s�76ief DATE: icr F1/C-1/
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:
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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 �1 u 4lare-0
LOCATION 9 S)\Q ) j
DATE I / •PERMIT NO. j
SOIL TYPE E Sand)- Loam - Clay -
Percolation Test Required? 'EYES - NO
Percolation rate - Min/Inch;
TYPE of SYSTEM:
Absorption field, total length
Length of each trench • 5 v
Depth of trenches ' t,!
Size of gravel > _
SEEPAGE PITS{Number of) ?y' / .
Size- ft. X ft.
Gravel size
PIPING: Size " Type
Bldg. to tank � / /%
Tank to dist. box 9 " f /
Dist. box to field/pit j
. Openings sealed? YES NO/ Partial
LOCATION/SEPARATIONS:
Foundation to tank i 66 ft.
' Foundation to absorption ft.
. Absorption to lot line
Separation 'of pits '(17 ft.'
LOCATION OF SYSTEM ON •ROPER,}rY(circle one)
Front - Left s• de - Right side -
COMMENTS:
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SYSTEM USE APPROVED® NO
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REC
SEP 1 1991
11.DG. & CODE bEPT.
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