1991-818 A
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date " M1J. -,A• 2619 1-1
This is to certify that work requested to be done as shown by Permit No. 91=818
has been completed.
This structure may be occupied as a SepticAltera o
Location
12 Barber Avenue
owner Peter read -
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. do Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No. 91-818
WARREN COUNTY, NEW YORK o
PERMISSION is hereby granted to Peter Mead •
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OWNER of property located at 12 Barber Avenue 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.
1. OWNER'S Address is
Same "
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2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer
792-7257
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3. CONTRACTOR or BUILDER'S Address Cr
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address C!
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6. TYPE of Construction—(Please indicate by X) rf
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( )Wood Frame ( ) Masonry ( )Steel ( ) •
7. PLANS and Specifications
No. Septic alterationto include: 200' of tile field using #2 stone
1' thickness as per plot plan specifications and application
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 D of NOvember 19 91
SIGNED BY ' for the Town of Queensbury
Building and Zoning spector
itifti fI t 5, ____02 ---3TOWN OF QUEENSBURY
OW APPLICATIO1 FOR SEPTIC DISPOSAL PERMIT
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DATE:J r 1 0 ' 9/ �REC Vr �j t.
LOCATION OF PROPERTY FOR INSTALLATION Id- Biiie.,t ,Lail i „ 3
Owner's Name: P QA---e cL ��/ £4- �R �^ •
Address: '.— 13 A-4_6 4P„ c/-A.—
Installer' s Name: c i-/J V5 f G..r.k„,_ Telephone: 7 5'c,) _ 7. J
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) 16'J
Topography: Circle one: tglp Rolling Steep Slope % of Slope
Soil Nature: Circle one: aq;) 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: unicipa Well Other
If domestic water supply is a wet :--
Separation: Water supply from an septic absorption feet.
Ciixts:JN G
PROPOSED SYSTEM: Septic Tank IC) 1D Q gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length r..:4) c) O feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used #'. :?..- /Depth or Thickness // 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 of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
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SIGNATURE OF RESPONSIBLE PERSON: /it.PiL DATE: /A- //d/)— 5
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 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 co lot lines
3.) location and distance to structures
4.) location and distance co any water supply
5.) size and dimensions of all ranks, distribution boxes.
_cile fields and/or drywalls
B. Nu system shall be covered before inspection and approval by the
building Inspuctor. 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
rusult 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 must
be submicced to the Queensbury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
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h,atiarks: :.
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_town of QueenJbur, yyJ
J;BUILDING and ZONING DEPARTMENT, 17" /
Bay and Haviland Road, R.D. 1 Box 98
Queensbury,_New York 12801 ' •
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME 7° ic.) /7/-fQ e
LOCATION ' / ,f 46,-"v'
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DATE // /9/ PERMIT NO. 9A- /d
SOIL TYPE San - Loam - Clay -
Percolation Test Required? "YES - NO
Percolation rate - Min/Inch ;
TYPE of SYSTEM:" • -
• . Absorption field total length Der)
Length of each tench= 501
Depth of trenches '. --3' ' /
Size of gravel' Z✓ / -
SEEPAGE PITS4Nuinb r of) .
Size- ft. X 'ft/ •
Gravel size . #r •
PIPING: size Type
Bldg. to tank , 41 ,�
Tank to dist. box ' SL1'
Dist. box to field/Y' t ep i
Openings sealed? ' E NO Partial
LOCATION/SEPARATIp S: ',
Foundation to to ak ft.
Foundation to absorption . 36 ft.
Absorption to 1 9ti't line ft. ,
Separation of is ft.
LOCATION OF SYSTEM ON PROERTY(circle one.)
Front -Qtear7 Left side Right side
COMMENTS:
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SYSTEM USE APPROVED YES NO
Bui ing Irisp ctor •
01/86 and vl • ' ' . .
. SANITARY SEWER SERVICE
LUZERNE RD. GLENS FALLS N.Y. PHONE 792-7257
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TOWN o QUEENSBi
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