1991-830 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date /6,6P419-44 „2_ 19
This is to certify that work requested to be done as shown by Permit No. 91-830
has been completed.
This structure may be occupied as a Septic Alteration
Location 14 Barber Avenue
Owner Christine Sherman
By•Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-830
WARREN COUNTY, NEW YORK c
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PERMISSION is hereby granted to Christine Sherman
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OWNER of property located at 14 Barber Avenue Street,Road or Ave. ^,
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 a
Same
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2. CONTRACTOR or BUILDER'S Name
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Sanitary Sewer ='
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
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( )Wood Frame ( ) Masonry ( )Steel ( ) 0
151
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7. PLANS and Specifications 0
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No. Septic alteration to include: 192' 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 25, 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 22nd Day of November 19 91
SIGNED BY �*! for the Town of Queensbury
Building and Zoning In r
/, TOWN OF QUEENSBURY 7`-�36
APPLICATIO'1 FOR SEPTIC DISPOSAL PERMIT
DATE: I I - EL - 9 i
LOCATION OF PROPERTY FOR INSTALLATION TO'F.W OF JEEP
Owner's Name: C r1�t ( cr � ,fir" � C1 . � .� �� ��1 v ' �
Address: B P'V`-c_ i��!-, NOV V 251991
Installer's Name: `\ ,4 >u r resic..d Telegpios(w 14r' .
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) V‘j
Topography: Circle one: 40lb Rolling__. Steep Slope % of Slope - -- _ -__ __ ---_�_--
Soil Nature: Circle one: qR) 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: _Municipal Well Other
If domestic water supply is a. well : -
Separation: Water supply from any septic absorption feet.
(_pc )N 6)
PROPOSED SYSTEM: Septic Tank ) O C7 0 gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench 3 2- feet/Total system length • /q2 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.
SIGNATURE OF RESPONSIBLE PERSON: Qz a 1 J /A—G£6- DATE: // - 9/
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bytiC System Inspections:
A. All applications for septic syscos 'installation. alteiati'on or iepair,
as required by the Town of Queensbury Sanitary Sewage Ordinance; shall
be submitted co the Building Department at lease-24 hOure before start ,
of construction and shall include a plot plan showing:
1.) the proposed location of Oa 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 ranks. distribution boxes,
tile: fields and/or drywe,lls t
B. Nu system shall be covered before inspection and approval by the
uuilding Inspuctor. Failure to comply with this requirement may
rdsulc in the uncovering of chd 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
sita. Failure co produce said plot plan at dime of inspection may
rusult in an immediate work stoppage: • '
D. Should unforeseen problems during conscruc'tion prevent proper installa—
tion, alteration or repair of an approved system. a new proposal must
bu submitted co the Queensbury building Departmonc before further
construction.
• Town of Queensbury
BUILDING and-CODES DEPARTMENT
• Bay and Haviland Roads
Queensbury, New York 12804
K.:marks:
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'' . _loran o/ Queeniur,'
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BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1'Box 98
• Queensbury, New York 12801
•
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME (A"!/ ::li>?i /}'i'/ala/
LOCATION / - a/(, i
DATE /0 /7/ PERMIT NO. 0--fg
SOIL TYPE Sand Loam - Clay - ,
Percolation Test, Required? YES -
Percolation rate - Min/Inch r
TYPE of SYSTEM:
Absorption field, total length a?'(sa
Length of each trench ' /
Depth of trenches --" I
Size of gravel ,- i
SEEPAGE PITS#Number of) ' ' /•
Size- ft. X ft. 1
Gravel size • ?, /
PIPING: Si Type
Bldg. to tank 4/" p(_� •
Tank to dist. box eA/
Dist. box to field/pit "\
Openings sealed? YES 0 Partial
LOCATION/SEPARATIONS: f .
Foundation to tank a.4 ft.
Foundation to absorption /l ft.
Absorption to lot l ne /,1' it.
Separation of pits ( 't.
LOCATION OF SYSTEM ON PROPERTY(.'rcle one)
Front - I Lef side - Right ide -
COMMENTS: •
SYSTEM USE APPROVED ® NO
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Bui ing Insp ctor
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