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1991-817 4,' ' —my°" (' . [.~ .,y..t' r . •_ _ +¶ ..• . r •N h r•l\Y )'•,_..fT l..e. —— • •_ _ r. r;R CERTIFICATE OF COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date ` A'//0infJi- [ 119 .9/ This is to certify that work requested to be done as shown by Permit No. 91-417 has been completed. This structure may be occupied as a Septic al terati o I,nation 6 Northam Drive Owner Rollin Pahl ion By Order Town Board TOWN OF QUEENSBURY (2a 7,7 Director of Bldg. & Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY No. 91-817 a WARREN COUNTY, NEW YORK , a 1-1 PERMISSION is hereby granted to Rollin Patti son •l OWNER of property located at 6 Northup Drive Street, Road or Ave. 1-1 1-1 1-6in 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 Same a r+ 1. N 2. CONTRACTOR or BUILDER'S Name 7 Sanitary Sewer 792-7257 • 3. CONTRACTOR or BUILDER'S Address —+• O 4. ARCHITECT'S Name tT rh 5. ARCHITECT'S Address 'C CD 6. TYPE of Construction—(Please indicate by X) N ( )Wood Frame ( ) Masonry ( )Steel ( ) 7. PLANS and Specifications No.Septic Alteration to include: : 300' of Tile Field using #2 stone t 1' Thickness as per plot plan specifications and application r+ 8. Proposed Use Septic Alteration $ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES November 19, 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 _ 19th ay o November 19 91 SIGNED BY for the Town of Queensbury Building and Zo Inspector . TOWN OF QUEENSBURY / APPLICATIOfi FOR SEPTIC DISPOSAL PERMIT /7 DATE: ( 1 15�- LOCATION OF PROPERTY FOR INSTALLATION N O X ky_ `.D Owner' s Name: R u ( ( w PATr( (r.Or' nre-,a, I n 1991 tJv Address: UDC. 8LCAJLA= uGr d Installer' s Name: --SmIiu i ,44 � U,s�,� Telephone: 9,X- 7ac� . Number of bedrooms (residential only) 3 Total daily flow (compute @ 150 gal per bedroom) ys-v Topography: Circle one: Flat> Rolling Steep Slope % of Slope Soil Nature: Circle one: Sand Loam Clay Other /Depth: Ground Water: At what depth? . 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: 4 unicipa ' Well - Other If domestic water supply is a. well : Separation: Water supply from any septic absorption feet. Est a PROPOSED SYSTEM: Septic Tank 1 0 O"o gal . (minimum size: 1,000 gal ) TILE FIELD: Each Trench feet/Total system length. 30 © feet SEEPAGE PIT(S): Number' of /Size each feet by feet Size of stone to be used Ca /Depth or Thickness if feet ***************************** 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 th Town of Queensbury Sanitary Sewage Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON: ..A TE: //'- /S �/ 11PtiC 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 co 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 drywalls-- . -- . - - - - - - - B. Nu system shall be covered before inspection and approval by the Building Inspector. Failure to comply with this requirement may rusult 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 co produce said plot plan at time of inspection may rusulc in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installa— tion, alteration or repair of an approved system, a new proposal musc big submitted co the Queensbury Building Department before further construction. • Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queunsbury, New York 12804 -remarks: J0Wil 01 Queeni ur y 9,, BUILDING and.ZONING DEPARTMENT Bay and H'aviland Road, R.D. 1 Box 98. Queensbury, New York .12801 SEPTIC(-DISPOSAL SYSTEM INSPECTION NAME /t'G1/v %S �d. LOCATION 6 / dsK.,,,j ' � , DATE ?./5'/ . PERMIT 9 N0. // /1--- 7 SOIL TYPE - ate:► Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch-_ ' TYPE of SYSTEM: Absorption field, total length, a Length of each trench 501 Depth of trenches • `- - Size of gravel 412__ . _ SEEPAGE PITS4Number of) ' Size- ft. X _ ft. Gravel size , . . J PIPING: - SizeJ. Type Bldg. to tank "/ . (iy ee/ Tank to dist. box 4l �1 !! Dist. box to field/pit LIP'• . 1j/(// Openings sealed? 1ES I NO I Partial LOCATION/SEPARATIONS': : Foundation to tank ft. _ Foundation to absorption 0 ft. Absorption to lot ,,line --- ft. Separation of pits 6, ft. LOCATION OF SYSTEM ON PI\OPERTY(circle one) Front Rea -Left side\ Right side - COMMENTS: \. SYSTEM USE APPROVED ® NO ,Bui ing Insp ctor - 01/86mdvl-- • - " . . SANITARY SEWER SERVICE LUZERNE RD. GLENS FALLS N.Y. PHONE 792-7257 -1 27 l000 C6:&f4 . Bait ss-0 6-0 • TOWN OF QU ENS UaY CODE(' DEPT . REVIEWED - -- DATE