1991-697 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 60 114-W, 1 19
This is to certify that work requested to be done as shown by Permit No.
9I-697
has been completed.
This structure may be occupied as a septic al terati on
3 New Pine Street
Location
Albert Dudley
Owner
By Order Town Board
TOWN OF QUEENSBURY
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Director of Bldg. & Code Enforcement
BUILDING PERMIT
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TOWN OF QUEENSBURY
No. 91-597
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to ALBERT DUDLEY
OWNER of property located at 3 New Pine Street Street, Road or Ave.
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in the Town of Queensbury,To Construct or place a Sept i r a1 tPra ti nn
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.
1. OWNER'S Address is
same
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2. CONTRACTOR or BUILDER'S Name -<
Condon' s Septic & Drain Service n
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3. CONTRACTOR or BUILDER'S Address cy
4. ARCHITECT'S Name
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5. ARCHITECT'S Address ro
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6. TYPE of Construction— (Please indicate by X) to
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( I Wood Frame ( ) Masonry ( I Steel ( )
7. PLANS and Specifications
No.Septic alteration to include 150 feet of tile field with #2 stone
at 1 foot.
8. Proposed Use
Septic system
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES September 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.)
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Dated at the Town of Queensbury this Day o tember 19 91
SIGNED BY r ,9i%t' a . for the Town of Queensbury
Building and Zon- Inspector
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` # j TOWN OF QUEENSBURY ' a rf
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # ,1/"0 I
Fee -Pai,d25 ,
Date: q-,36 - i/
( Reviewed `B
LOCATION OF PROPERTY FOR INSTALLATION: D /g Lt) '1 ii E •
Owner' s Name: A,oL e "7q - q 3
Owner' s Mailing Address: 3 p 6 611 E
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Installer' s Name: 09/1/ /1) S
' Ff) Phone #: H4rD
Number of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 _gal . per bedroom) : 300
Topography-Circle One: 411110 Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth: •
Ground Water-At What Depth? 0 Feet
Bedrock or Impervious Material-At What Depth? 1l/f� Feet
Percolation Test-Circle One:�Not Require Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other
If domestic water supply is a we -
Separation: Water supply from any septic absorption feet
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PROPOSED SYSTEM: Septic Tank 1000 gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench ,,j 0 feet//Total System Length. 16—U feet
Seepage Pit(s) : Number of / Size each: ft. x ft.
Size of Stone to be used: # 71 / Depth or Thickness 1 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 Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: DATE: 0 ��
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:
aV � l
`-a%u'n of Queeni6ur, •
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 DC)�C�1 S� rt 1,9„1-
LOCATION J ��v �kV
DATE /( / 7 PERMIT NO. / / -6
SOIL TYPE - nd1- Loa - Clay -
Percolation Test Required? YES
Percolation rate - Min/Inch
TYPE of SYSTEM: O
Absorption field, total, length L SC:
Length of each trench 3-0
Depth of trenches • rir
Size of gravel Zi •
SEEPAGE PITS{Nuinber of); •
Size- ft. X ft' iV/f�-
Gravel size .
PIPING: / Size Type
Bldg. to tank 6 tic .t'C
Tank to dist. box- j -
Dist. box to field•' t-j' rv-c.-
Openings sealed? : liMP NO Partial
LOCATION/SEPARAT IONS:
Foundation to tank (iris i tia-ft,
' Foundation to aibsorption f
Absorption to Yot line fts
Separation of its N/,,¢ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear I c eft!'sid - Right side -
COMMENTS:
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SYSTEM 'USE APPROVED Y NO
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