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CERTIFICATE OF COMPLIANCE'
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date (,A / // 19 0
This is to certify that work requested to be done as shown by Permit No.93-094
has been completed.
This structure may be used as a. septic, system
Location 15 Richardson Street
Owner • Gene and Sandra Lashway
By Order of Town Board
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TOWN OF QUEENSBURY. -'� •
Director of Building & Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBURY •
No. 93_094 f`�� •
WARREN COUNTY, NEW YORK / w
cn
PERMISSION is hereby granted to GENE AND SANDRA LASHWAY
OWNER of property located at 15 Richardson Street 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
same
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2. CONTRACTOR or BUILDER'S Name z
I BS `�'
3. CONTRACTOR or BUILDER'S Address p
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
J.
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6. TYPE of Construction—(Please indicate by XI 0
( 1 Wood Frame ( 1 Masonry ( 1 Steel ( ) to
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7. PLANS and Specifications
Septic alteration to include 1000 gallon septic tank and one 8'x10'o.
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seepag"e'pit as per plot plan, specifications and application.
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8. Proposed Use
septic system
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 13 ig 95
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the r+
town of Queensbury before the expiration date.) -
a)
Dated at the Town of Queensbury this 13th /ID
y of Aprl1 �g 93
SIGNED BY � for the Town of Queensbury
Building and Zoning I ctor
of1
j TOWN OF QUEENSBURY 31—S— / 7
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
FeeivP gd QUEEN8L,u,
RECEIVED
Date: 11 /3 93 Reviewed By
APR -. 01993
LOCATION OF PROPERTY FOR INSTALLATION: f , CA rc/s cm, it
1 mt.& & CODE DEPT.
Owner' s Name: �'{ ' -� ,5'4cl�'`C�,, ,L.i� Lr h�a�y
Owner's Mailing Address: i1 5-,67
Installer's Name: ? Ur, /3-c-i1 Phone #: 7 9S7 15
Number of bedrooms (if residential ): ,
Total daily flow (residential-compute @ 150 gal . per bedroom) : 3420
Topography-Circle One: la Rolling Steep Slope % of Slope
Soil Nature-Circle One: Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? '24 Feet
Percolation Test-Circle One: of Require Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: 'unicipa Well Other
If domestic water supply is a we -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank /e2C217gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench -214 feet//Total System Length "34 feet
Seepage Pit(s) : Number of / / Size each: 8' ft. x y/1 ft.
Size of Stone to be used: # 13 / Depth or Thickness feet
**************
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks , Size\of Each 2i 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. �Q
SIGNATURE OF RESPONSIBLE PERSON: i� ��t" DATE: 9 ,3 7,
04.
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 the 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 dry-wel l s
B. No system shall be covered before inspection and approval by the Building
r 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: ' •
0_607
TOHN OF QUEENSBURY ern
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name Z.lk_PXaa1A
Location //si
Date � 3 Permit ,# g3,6,q L
SOIL PE: "an•-,oam-Clay-
Results of Percolation;Test-
(if applicable) Rate-Mainute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench?
Depth of trenches
Size of stone
SEEPAGE PITS: Number- I
Size - ' ft. x; ro ft
Stone size 3- 4f if 1
PIPING: j. Siz,e Type
Bldg. to Tank
Tank to Dist. xP' r cf P
c
Openings Sealed? 'Yes No Partial
LOCATION/SEPARATIONS, ,
Foundation to Tank ;w /n feet
Foundation to Absorp ion feet
Separation of Pits / P'' — feet
Conforms as per Plpt Tl an Yes No
LOCATION OF SYST N O4 PROPERTY:
(circle one
Front - gear eft Side - Right Side
Middle Front Middle 1Rear ,
COMMENTS: i=
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1 J051
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SYSTEM USE APPROVED: 41b NO
Arrived: 2: 30
Departed:
' VEarlry Inspector
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TOWN OF Q.,;.. \.: ,z-NS BU R.Y:.._
BUILDING vikv 1ES DEPT. • i
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