1991-852 .3
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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date December 18, 19 91
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This is to certify that work requested to be done as shown by Permit No. 91852
has been completed.
This structure may be occupied as a Septic Alteration
Location Box 254 Yorkshire Drive
Owner Jose.h Monde la
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
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BUILDING PERMIT
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TOWN OF QUEENSBURY a
No. 91-852
WARREN COUNTY, NEW YORK c
PERMISSION is hereby granted to Joseph Mondel l a '
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OWNER of property located at Box 154 Yorkshire Drive Street, Road or Ave. c
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in the Town of Queensbury,To Construct or place a Septic Alteration 1-1
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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 0
Same a
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2. CONTRACTOR or BUILDER'S Name
Condon's Septic & Drain H
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name -1
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) N
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( )Wood Frame ( ) Masonry ( )Steel ( ) .�i.
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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 a
#3 stone, 2' Thickness as per plot plan specifications and application
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8. Proposed Use =
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES December 10, 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 is . Day of December 19 91
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SIGNED BY . \ ! Cf/j, for the Town of Queensbury
Building and Zoning Inspector
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_ 9 TOWN OF QUEENSBURY j
F$j —So APPLICATION FOR SEPTIC DISPOSAL PERMIT �`��
1 f a OF QUEENS
DATE: I 9 / RECGi /FQ
LOCATION OF PROPERTY FOR INSTALLATION ?OX o 5 7oAiS/? / EI iPA991
Owner's Name: DOSE fh Mew el1 .D
Address: go X / ���''1���/ �'� RK
LShi /;- 67uF�itI.sati
Installer's Name: LOit/Zpiv S SP 6 �c' , -4-)/A4//U Telephone:
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) y,(C)
Topography: Circle one: Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand Loam Clay Other /Depth:
Ground Water: At what depth? /1J,/A Feet
Bedrock or Impervious Material : At what depth? J1/,4 Feet
Percolation test: Circle one: not required required
Rate - Min. Per Inch
Domestic water supply: Circle one: Municipal i72i7 Other
If domestic water supply is a well :
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank/600 2/ gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of 2-- /Size each $ feet
by feet
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Size of stone to be used #: 3 /Depth or Thickness 2_, feet
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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: DATE:
Sestis 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 cho system
2.) location and distance co lot lines
3.) location and distance co structures
4.) location and distance co any water supply
5.) size and dimensions of all tanks, discributionboxea,
cile fields aria/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 cht 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 immeediace work stoppage.
D. Should unforeseen problems during construction prevent proper installa-
tion, alteration or rdpu it of an approved system, a new proposal must
bu submitced to .che Queunsbury Building Department before further
construction.
Town of Queensbury •
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
ti.:ni;,►rks: :.
• cc-7� / : 'x l.i w—nn Orli,
'own .of Queeniburcy r'
• BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL�� A SYSTEM INSPECTION/
NAME \Ioe_7 �C /7/-9.�= f��,�
LOCATION 1 JJ,A-- 753 .:.i lL' a
DATE 42-%j" / -/ PERMIT NO. W-�� r
SOIL TYP - Sane -(Lo n - Clay -
Percolation Test •equi ed? YES - NO
Percolation rate Mi /Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each tren•h"
Depth of trenches ',
Size of gravel __ /
SEEPAGE PITS-fNuinb-r .f)
Size- '-; 'j`ft. X f .
Gravel size . /
PIPING: Size Type.
Bldg. to tank /
Tank to .dist. pox 5(
Dist. box to flield/pi. 4_,
Openings sealed? YE NO Partial
LOCATION/SEPARATIONS: •
Foundation o to tank ft.
Foundation to absorptions ft.
,Absorption/to lot line ft.
Separation of pits 't4, ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - RJear - Left side - Right side -
COMMENTS1
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SYSTEM USE APPROVED tfES NO
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REVIEWED BY f, -
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