1991-846 ••
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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date /441-4/44-2/.42., // 19 0/
_(.21 L 301
This is to certify that work requested to be done as shown by Permit No. 91846
has been completed.
This structure may be occupied as a Septic Alteration
Location 11 exadarlorellnd Dri wP
Owner Valter Brown
By Order Town Board
TOWN OF QUEENSBURY
V
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY . '
No. 91-846 0
WARREN COUNTY, NEW YORK
CO
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PERMISSION is hereby granted to Walter Brown ~'
OWNER of property located at 11 Cedarwood Drive 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. co
0
1. OWNER'S Address is
Same
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2. CONTRACTOR or BUILDER'S Name
Jack Hall Plumbing & Heating
3. CONTRACTOR or BUILDER'S Address
N
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4. ARCHITECT'S Name
2
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications —''
No. Septic Alteration to include: 100' of Tile Field using 02 stone
1' Thickness as per plot plan specifications and application
8. Proposed Use
e+
Septic Alteration 0
$ 25.00 PERMIT.FEE PAID —THIS PERMIT EXPIRES December 9, 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 9th f D c e 19 91
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
6d 5 7/ '/-
eat: TOWN OF QUEENSBURY 1
oirvi • APPLICATIO�J FOR SEPTIC DISF�SAL PEQIIIT
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DATE: , 1 •
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• LOCATION OF PROPERTY FOR INSTALLATION.' // Cep'4ra,d 0L,Ka
Owner's Name: .I410 lllei'' R rot-0 V\ B ARg oliN F CODE DEPT.
Address: // Cee/aca.)add Or- ' a U e'v.s6or/
Installer's Name: Jack 4_/c11/ Pivi4)Ln; - Ae61M, 'Telephone:
Number of bedrooms (residential only) 3
Total daily flow (compute @ 150 gal per.bedroom)
Topography: Circle one: 415, Rolling Steep Slope % of Slope
Soil Nature: Circle one: Loam Clay * Other /Depth:
y •
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what depth? , Feet
Percolation test: Circle one: not re ui required
Rate - ---- - Min. Per Inch
Domestic water supply: Circle one: unicip Well Other
If domestic water supply is a well :
Separation: Water supply from any septic absorption feet.
_ PROPOSED SYSTEM: Septic Tank ��x15i "& gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench s v feet/Total system length /D o feet
SEEPAGE PIT(S): . Number. of /Size each feet
by feet
Size .of stone to be used #... o1 /Depth or Thickness /• feet •
t**************************** , .
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
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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. -
ON.RESPONSIBLE PERSON: ��'
SIGNATURE OF ,- DATE. ,Derma �a 9 1
.
jowl ftstem Inspeccions:
A. All applieacions 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 shoving:
1.) the proposed location of tho system
2.) location and distance co lot lines
3.) location and distance co structures
- 4.) location and distance to any water Supply
5.) size and dimensions of all conks, distribution boxes.
rile fields any!/or drywells
B. Nu system shall be covered before inspection and approval by the
uuilUing Inspector. Failure to comply with this requirement may
result in the uncovering of chi system by the installer and a fine
of up co $250.00.
C. An approved copy of the plot plan shall be available an the construction
sic,. Failure co produce said plot plan at dine of inspection say
result in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper inscalla—
cion, alteration or rupuir of an approved syscea. a new proposal must
bu submitted co the Queunsbury Building Department before further
conacruccion.
Town of Queenabury
BUILDING and CODES DEPARTMENT
• Bay and Haviland Roads
Queensbury, New York 12804
k.Jmarks: .
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--,, -07:1;
-1 c7 //
1 • ,'own of Queenaurty
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
•Queensbury, New York.12801
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SEPTIC DISPOSAL SYSTEM INSPECTION
NAME `Q,�iLt QA,o'rGD7-1 .
LOCATION
// Cyr (w��z,wee. 4i
DATE ./2//i/el/ PERMIT NO. 9/-1
SOIL TYPE -(San Lo. - Clay - '.
Percolation Test Required? YES ° NO
Percolation rate - Min/Inch _ , '
TYPE of SYSTEM: !
Yf
Absorption field, total lend 0,0v
Length'of each trench 66
Depth of trenche . T /
Size of gravel' ,
SEEPAGE PITS4Nuinber rof) 11
Size- ft. X ft. / .
Gravel size
PIPING: % ize Type
Bldg. to tank ti i) P
Tank to dist. box V�, PVC,
Dist. box to field/ it y 941
Openings sealed? ES ' NO Partial
LOCATION/SEPARATI S:
Foundation to to J ft.
Foundation to ab orption �J ft.
Absorption to 1 t line ,25 ft.
Separation of p is ' \g(o ft. .
LOCATION 0. . SY EM ON PROPERTY(circle one)
Front " - Left side - Right side -
COMMENTS:
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