1991-720 mirmimmor
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 1/�d�/ ,�(i9 92_
This is to certify that work requested to be done as shown by Permit No. _ 91-7 20
has been completed.
This structure may be occupied as a Seoti c Al terati on
Location?. t 9 Prospect Drive
Owner Robert Matheny
By Order Town Board
TOWN OF QUEENSBURY
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Director of Bldg. do Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-720
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Robert Matheny
OWNER of property located at 9 Prospect Drive Street, Road or Ave. •w
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 et
Same
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2. CONTRACTOR or BUILDER'S Name
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Carl Dingman
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address rD
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6. TYPE of Construction—(Please indicate by X) 'fl
( I Wood Frame ( I Masonry ( I Steel ( )
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7. PLANS and Specifications fD
Septic Alteration to include:
No. 1000 gal tank with 2 seepage pits each 8' x 8' as per plot plan o.
specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 16, 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 ay October 19 91
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SIGNED BY for the Town of Queensbury
Building and Z ng Inspector
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APPLI • i p;? %,"'TIC DISPOri TOWN ��
OF QvEENQ674J h47
DATE: /o /.S % RECEIVED
LOCATION OF PROPERTY FOR INSTALLATION ? 04€25q P of D200 j51991
Owner's Name: Ro 6, -r 7-7/ „
EPT.
Address: 9P.4 g PA-Cif pgf.S vc=� � �s � -et),"
Installer's Name: (-1,4 ;Ajc, , Telephone: (.3 3e— . 3 90
Number of bedrooms (residential only) 3
Total daily flow (compute @ 150 gal per bedroom) ?
Topography: Circle one: 41113110 Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand ' Loam Clay Other /Depth:
Ground Water: At what depth? � ,,(,r tl,-% Feet
Bedrock or Impervious Material : At what depth? 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 fi-0 gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of /Size each P feet
by feet
Size of stone to be used #.. /Depth 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•. i�/4 �,.Iv ,ta —/S= 9/
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logic System Inspections,:
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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 co any water supply
5.) size, and dimensions of all tanks, distribution boxes. •
-cile_f.ields. and/or drywalls - - — - - -
B. Nu system shall be covered before inspection and approval by the
!Building Inspuccor. Failure co comply with this requirement may
rusulc in the uncovering of the system by the installer and a fine
of up co $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure co produce said plot plan ac time of inspection may
rusulc in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installa-
cion, alteration or repair of an approved system, a new proposal must
bu submitted co the Queensbury Building Department before further
conscruction.
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Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queeensbury, New York 12804
Remarks:
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Pc(r\--2-rt:
N , own of Queenit urn
} (, BUILDING and ZONING DEPARTMENT .
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME \C P;Ncl , p aaeA
-A- •
LOCATION 9 0---(vee-1
DATE /O / a3 PERMIT NO. I 1;20
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches •
Size of grave !^�
SEEPAGE PITS{Number of)
Size- ¶ ft. X ft.
Gravel size .
PIPING: Size Type
Bldg. to tank 11 f, SC-II- ' 0L i .
Tank to dist. box . r:
Dist. box to field/pit
Openings sealed? YESR• NO Partial
LOCATION/SEPARATIONS:,
Foundation to tank Yy. !4, ft.
Foundation to absorption
Absorption to lot line ft.
Separation of pits ,1 ft.
LOCATION OF SYSTEMjON PROPERTY(circle .one)
Front - Rear - Lefit side - Right side -
COMMENTS: I •
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SYSTEM USE APPROVED YES N�•, 1)
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Bui ing I' spe,tor
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TOWN OF QUEENSBU
L / RECEIVED
OCT 15 1991
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BLDG. & CODE DEPT.
IN
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$1.144
37
40
'►� frier/Xney
9 PROSPECT .MI
Queens bul-y i 647*
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