1991-753 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date OctnbPr 23 19 91
This is to certify that work requested to be done as shown by Permit No. 91-753
has been completed.
This structure may be occupied as a/7g septic alterations
ocation MartP11 Ropii
Audrey Swift
Owner
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
- - •
•
BUILDING PERMIT .�
TOWN OF QUEENSBURY
No. 91-753
WARREN COUNTY, NEW YORK
•
PERMISSION is hereby granted to Audrey Swift .�
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OWNER of property located at Martell Rd Street, Road or Ave. oti
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in the Town of Queensbury,To Construct or place a Septic Alteration ro
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
Jay Sweet.
3. CONTRACTOR or BUILDER'S Address 3
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4. ARCHITECT'S Name
5. ARCHITECT'S Address t!f
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6. TYPE of Construction— (Please indicate by X) `�
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( I Wood Frame ( 1 Masonry ( I Steel ( ) 's`
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7. PLANS and Specifications 0
No.Septic Alteration to include: 125 ft of Tile Field using #2 Stone
10" deep as per plot plan specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 23, 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 23rd Day of October 19 91
SIGNED BY '40 - for the Town of Queensbury
Building and ning Inspector
(i - 5- 6 SJ-
111111
``� j TOWN OF aViS _ ' =a;=.mot` 1. '
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
Fee Paid
OCT 2 21991
Date: tf r 6 BLDG. CODE DEPT.
Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: C:NVVLtMI f ,
Owner' s Name: u
Owner' s Mailing Address: PC(4- 7e:.,'/ e,' � 04
Installer' s Name: ( e_e,�jS 1 u_+r' P �> rzv^
� � Phone #: G'7---02-e%
Number of bedrooms (if residential ): 2
Total daily flow (residential-compute @ 150 gal . per bedroom): -07'
Topography-Circle One: T j) Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Lon Clay Other /Depth:
Ground Water-At What Depth? 1 Feet
Bedrock or Impervious Material-At What Depth? _ Feet
Percolation Test-Circle One: ' • Re•uir-a Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipala ► Other =" a A
If domestic water supply is a well - /"
Separation: Water supply from any septic absorption A.->e feet ,. , -
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PROPOSED SYSTEM: Septic Tank gal . (Minimum size: 1;.;000a ) '� ..
Tile Field: Each Trench -b feet//Total System Length --c feet
Seepage Pit(s) : Number of / Size each: ft x-- ft.
Size of Stone to be used: # 7 / Depth or Thickness "0 '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�zv /
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:
1
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-own o/ Queenb100
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• BUILDING and ZONING DEPARI.
Bay and Haviland Road, R.D. 1 NT
•Queensbury, New York 128( 98
SEPTIC DISPOSAL SYSTEM INSPF
NAME � y 4,0( r 6TI0N
LOCATION 4T06(Vc.„-Q. (:)
DATE /( / / 3 PERMIT NO. " I J 75 3
SOIL TYPE - Balza, t Loam i Clay - ,/
Percolation Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length /25-
Length of each trench ' YO - 'f S
Depth of trenches l ' /
Size of gravel 02 /
SEEPAGE"PITS4Number of)
Size- ft. X fit.
Gravel size
PIPING: Size T pe
Bldg. to tank /6;iY/ 1
Tank to dist. box y > ® t:
Dist. box to field/ ' ` ( cf Y/440
Openings sealed? E NO Partial
/
LOCATION/SEPARATIONS: 's FP
Foundation to tank -u�
t6 ft.
Foundation to absorption/ 39 ft.
Absorption to lot line /
Separation of pits r \ ft. .
LOCATION:OF SYSTEM ON (PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS: G
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oil /'Or)
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gale
SYSTEM USE APPROVED YES N
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TOWN OF S C7! ',. ,'7. 7,.7!,' Ei L,;R.Y
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REVIEWED BY
DATE
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