1991-701 G t •
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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSEURY
,.:WARREN COUNTY, NEW YORK
Date '101.0--J u ;2-- 19 qI
This is to certify that work requested to be done as shown by Permit No. 91-701
has been completed.
This structure may be occupied as a Se�5i Alteration
Location Howard Street
Owner Patrick Green
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. do Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-701
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Patrica Green
OWNER of property located at Howard Street 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
Box 116 Howard Street a
Queensbury, NY 12804 e+
2. CONTRACTOR or BUILDER'S Name
Steven Sanders a
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name pi
a
e+
5. ARCHITECT'S Address
6. TYPE of Construction— (Please indicate by X)
( )Wood Frame ( ) Masonry ( I Steel ( ) N
fD
e+
7. PLANS and Specifications
No. Septic alteration to include: 200' of Tile Field using #2 Stone
1' Thickness as per plot plan specifications and application
8. Proposed Use
e+
Septic Alteration 0
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 2, 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 t D of October 19 91
SIGNED BY �G for the Town of Queensbury
Building and Wing I ctor
TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # ;0- 7'd/
Fee Paid e41-
Date: 9- 3o '6?( 1 Reviewed By -_
LOCATION OF PROPERTY FOR INSTALLATION: / ( )c
Owner' s Name: D Otl-riQQ( Qreee'i
Owner' s Mailing Addrp.ss aox ) l(, gYe( S t
Installer' s Name: (-3f`cvr'in So/No/ r ) Phone #: 2°V- `fir/ /
Number of bedrooms (if residential ) : 73 /
Total daily flow (residential-compute @ 150 gal . per bedroom) : -V5 C,
Topography-Circle One: lat Rolling Steep Slope % of Slope
Soil Nature-Circle One: ' .nd Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? --- Feet
Percolation Test-Circle One: moo#-AeQui're Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: an -cipal Well Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
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PROPOSED SYSTEM: Septic Tank lobo gal . (Minimum size: 1,000 gal . )
Tile -Field: Each Trench $O feet//Total System Length 2 v O feet
Seepage Pit(s) : Number of / Size each: ft. x ft.
Size of Stone to be used: # 9. / 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: /���_-�-� Gv '-/�
a DATE: /7-3CP-" /
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:
`Jocun of Queenitury 411
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98 .
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM/ INSPECTION
NAME P�,�;/�-f.C'1-1U %-/4 Q olt)
/
LOCATION /A 4)(7.d0,l t
DATE /Q/4Z/ r/'( PERMIT NO. 9X4
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM .
Absorption field, total length ' z)-n
Length of each ench' d0
4tr
Depth of trenche's -JJ
Size of gravel t ' "
SEEPAGE P ITS4Nuinber! of) '
Size- ft. X Jft.
1.
Gravel size , 1
PIPING: ! '\Size Type
Bldg. to tank �' �; �' I1Ct,
Tank to dist. box {i .ek' g(/(1-
Dist. box to field/pit e. ''!
Openings sealed? d,I',' YES ONO Partial
U. hS
LOCATION/SEPARATIONS: `^;
Foundation to tank 1'\\ft.
Foundation to absorption .
Absorption to 14t line j[j ft,.
Separation of pits 6 ft\
.
LOCATION OF SYS M PERTY(circle one)
Front - Rear -Left side - Right side -
COMMENTS: t
;
SYSTEM USE APPROVED 4100 NO
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