1991-791 ektt
CERTIFICATE OF COMPLIANCE .
TOWN OF QUEENSBURY
ARREN COUNTY, NEW YORK
304 Date 17/0Yel7a-gt 13 19 fjf
This is to certify that work requested to be done as shown by Permit No. 91-791
has been completed.
This structure may be occupied as a Septic Alteration
Locatioj Caro' niSeStrer,t
Owner John E mond
By Order Town Board
TOWN OF QUEENSBURY
„17
Director of Bldg. & Code Enforcement
BUILDING PERMIT .�
TOWN OF QUEENSBURY
No. 91-791 a v
WARREN COUNTY, NEW YORK a
PERMISSION is hereby granted to John Esmond
OWNER of property located a6 Caroline Street Street, Road or Ave. o
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.
1. OWNER'S Address is n'I
Same c
a
2. CONTRACTOR or BUILDER'S Name C+
O
Queensbury Sewer
792-3648
3. CONTRACTOR or BUILDER'S Address
LC/
C')
-s
4. ARCHITECT'S Name O
fD
• N
5. ARCHITECT'S Address :*
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
Septic Alteration to include: 1000 Gal . Tank with 130' of Tile Field
No. using #2 stone, 10" Thickness as per plot plan specifications
and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES November 13, 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 th Day November 19 91
SIGNED BY ' _ % for the Town of Queensbury
Building and Zoning spector
5 Awl
j TOWN OF ,QUEENSBURY
APPLICATION FOR SEPTIgaISPQ@AL PERt4391 Permit #9 ( 7 91
Fee Paid 05 , C(7
,�-, uiLDIN CO ® P` .
�
Date: /Vv �7 T 6 -- g( Reviewed By
LOCATION OF PROPERTY. FOR INSTALLATION: n5 Cb /i k _o,,
Owner's Name: h , )5,5:-Otb �.
Owner's Mailing Address: ? ( i aro h S l ,
Installer' s Name: l 1 e P Gvs,�r�, 2cu,ry Phone #: 1--- 3 5Z r
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom): 63-27
Topography-Circle One: at Rolling Steep Slope % of Slope
Soil Nature-Circle One: San Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One:(16t—Require' Required/Rate Min, Per Inch
Domestic Water Supply-Circle One: , ► Well Other
If domestic water supply is a we -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank7c-O gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench 40 feet//Total System Length / o feet
Seepage Pit(s): Number of / Size each: ft. x ft.
Size of Stone to be used: # 9 / Depth or Thickness w 4r 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: 947/2/1' DATE: elia2
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:
_own. o� Queenit urt� .,/
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98 - `q,
- Queensbury, New York 12801 i.....„
SEPTIC DISPOSAL SYSTEM INSPECTION '
NAME ri3 MrM.fn
LOCATION ci e7 1..(,u
DATE OI f I / 9i PERMIT NO. qi-is / .
SOIL TYPE - Sand - Loam - *Clay -
Percolation Test Required? YES - NO ,
Percolation rate - Min/Inch . '
TYPE of SYSTEM: -
Absorption field, total length .. / 3 U
Length of each V trench' ` j L 1 D -y/S
Depth -of trenches " 15'=r-
Size of graver :it-z..--
SEEPAGE PITS{ umber of) ) ,•,._.--
Size- ft. X ft .--`._., --- .�- --
Gravel size _ ' . _..!---
PIPING: 'Siz'e Type
Bldg. to tank ,
Tank to dist.. 'bd: _ _ / _
Dist. box to fie 'id/ j
Openings sealed? vs) VNO Partial
LOCATION/SEPARATI9 \S:
Foundation to to
P lc ft� V
Foundation to' asorp 'on •ft 0 it '
Absorption to !ot line ft/
Separation of pits ` /j„//)--f
LOCATIONOE�•�9YSTEM ON P. OPERTY(circle one)
Front �'Rear`J`��� Left side Right side -
COMMENTS• x`
• -'-‘-\ ^j
SYSTEM.USE APPROVED( YES) /N0 _ /- / ,-)
Building Inspector L
01/86 and vl ,
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