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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 0711I sf, 4" 19 9/
This is to certify that work requested to be done as shown by Permit No. 91-835
has been completed.
This structure may be occupied as a Septic alteration
Location SRO Dixon Road
Owner Richard Chap
By -Order Tow4 Board
TOWN OF QUEENSBURY
/17
Director of Bldg. at Code Enforcement
BUILDING PERMIT
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TOWN OF QUEENSBURY
No. 91-835
WARREN COUNTY, NEW YORK •
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PERMISSION is hereby granted to Richard Chapman c)n
OWNER of property located at 590 Dixon Road Street, Road or Ave. ro
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. w
1. OWNER'S Address is
SAme =46
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2. CONTRACTOR or BUILDER'S Name
Queensbury.:Sewer
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3. CONTRACTOR or BUILDER'S Address
O
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4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( 1 Masonry ( )Steel ( ) ei
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7. PLANS and Specifications
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No.Septic alteration to include: 2 seepage pits each 8' x 8' using
#3 stone, 2' thickness as per plot plan specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES December 2, 19 92
(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 thi d Day o/ December 19 91
SIGNED BY C /,G for the Town of Queensbury
• Building and Zoning/Inspector
lvj TOWN OF QUEENSBURY rt��P� �3F C,l! �� ,� p
APPLICATION FOR SEPTIC DISPOSAL PERMIT ,,-FewrSb# 9/f
REJEPeeDPaid itr 5
p r 2 1991 r l
Date: 0 2 Reviewed By ! '0
LOCATION OF PROPFIY FQR INSTALLATION: ! /c--- a 714/ gEFil 1101
Owner' s.Name: IDYL.-� _ C� /( e id,
Owner' s Mailing Address: 3c Di d 2 4,-).
Installer' s Name: 621 coed,5(3 0, e- Lt.) Phone #: 7."--,,2 /7',(o
Number of bedrooms (if residential ): 5
Total daily flow (residential-compute @ 150 gal . per bedroom) :
Topography-Circle One: 4111, Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sa4) Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: of Requir) Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: AialnIngto Well Other
If domestic water supply is a 'well - •
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank ''ozr gal . (Minimum size: 1,000 gal .')
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s): Number of c.,Z / Size each: ft. x F ft.
Size of Stone to be used: # -3 / Depth or Thickness 2 " 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: ',2 -//
1
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 th'e 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 drywel.ls.
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:
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`town of oQueenibutry`
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTpIC DISPOSAL SYSTEM INSPECTION
NAME C XNG YY\.AA,-, RGACk.`r)
LOCATION , D arn�
DATE izi-t PERMIT NO. CP C1
SOIL TYPE an - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch ,
TYPE of SYSTEM: .
Absorption field, total length
Length of each trench
Depth of trenches
Size of gravel ) _
SEEPAGE PITS*Numb-.__ of) L
Size- Oft. X ft. I /
Gravel (ff0 a .
PIPING: Sie Tye
Bldg. to tank
Tank to dist. box
Dist. box to field/pit gvCJ
Openings sealed? YES I4O . Partial
LOCATION/SEPARATIONS:
Foundation to tank '4,ft.
Foundation to absorption ,#tft. '
Absorption to lot line / 3r6 f`t.
Separation of pits
LOCATION OF SYSTEM ON PROPERTY.(circle one)
Front ea - Left side - Right side -
COMMENTS:
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SYSTEM USE APPROVED 40 NO
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