1993-114 p ; � CE '" TI FIOATE ••11 , COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date (2 L' 19 /22
This is to certify that work requested to be done as shown by Permit No. 93-114
has been completed.
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This structure may be used as a septic system
Location Pitcher Road
Owner Carol Henderson
125-2-9 By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBURY No 93-114
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to CAROL HENDERSON
OWNER of property located at Pitcher Road 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.
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1. OWNER'S Address is
RD#3 Pitcher Rd
Queensbury NY 12804
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2. CONTRACTOR or BUILDER'S Name -�
Sanitary Sewer Service
TUXR224 R or BUILDER'S Address
Glens Falls NY 12801
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( I Wood Frame ( ) Masonry ( I Steel (
7. PLANS and Specifications
No. Septic alteration to include one 10'x8' seepage with with #3 stone at .
two foot depth as per plot plan and application.
8. Proposed Use Op
ct
Septic system
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 21 19 95
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the O
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 21st Day of April 19 93
SIGNED BY 1/7/2-7_, i 0 �J//� for the Town of Queensbury
fi an oning Inspector
Agri j
TOWN OF QUE stmEERS �: ��
APPLICATION FOR SEPTIC DISPO '. tIVOT Permit # 93 -1/L/
Fee Paid /645
APR Z-1'- 1993
Date: 1 2Q s 9_2 Reviewed By
gS)®EPEP' . 2")
LOCATION OF PROPERTY FOR INSTALLATION: C
/ ee,_ 72. .
Owner' s Name: eig-ra (_____ /4/073.e/t_crOA)
. Owner' s Mailing Address: f D3 Pe/
Installer' s Name: jrAiu / 7794. aq .t..{_, Phone #:
Number of bedrooms (if residential ) :
Total daily flow (residential-compute- @-150 gal . per bedroom) : ci (J-�.-
Topography-Circle One: Fla Rolling Steep Slope % of Slope
Soil Nature-Circle One: San. Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: Clot.. uiredRequired/Rate Min. Per Inch
Domestic Water Supply-Circle One: - ntrp Well Other
If domestic water supply is a we- -
Separation: Water supply from any septic absorption feet
C - --' '
PROPOSED SYSTEM: Septic Tank IC)0 C) gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s) : Number of / / Size each: ft. x rft.
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 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 e Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: IA✓ . DATE:
..
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 drywells
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:
TOM OF QUEE 1SBJRY
BUILDING & CODE ENFORCEMENT AQ cork
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ed # �
Location ' Jt
Date /,.49/1/Y Permit #
SOIL TYPE: Sand oam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch !V fil—
TYPE OF SYSTEM:
ABSORPTION FIELD: .Total,; Length
Length of each trenc
Depth of t s
Size of- stone
SEEPAGE PITS: Number-
Size - ' .ft. ';x/ (0 ft.
Stone size
PIPING: e.4
, , Si4p Type
Bldg. to Tank y Sco-40
Tank to Dist. Box \ ,:
Dist. Box to Field/Pit, 'A
Openings Sealed?) Yes, No Partial
LOCATION/SEPARATION : \
Foundation to Tank feet
Foundation to Absorption �, feet
Separation of ,its feet
Conforms as pep' Plot Plan \, Y No
LOCATIO1 OF SVSTE 3 ON PROPERT?-ti
(circle one) r
Front - R a1 eft Side , Right\Side
Middle Front •- Mfddl a Rear
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrived: /kz
Departed: //Z.3.; /
I
Building lnspectoy
TO?thN iF QUEENSBURY
BUILDING G CODE ENFORCEMENT A
' 531 Bay Road }
Queensbury NY 12804 (GLe.1- l�/
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 412 *4'?244fl41)
Location
Date G// /qn Permit # q3 -//5
SOIL TYPE: QM-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number- /
Size - 8 ft. x g ft. fa' .1�
Stone size ,7,4 3 ,4y
PIPING: Sze Type
Bldg. to Tank r
Tank to Dist. Box!,
Dist. Box to Field/P . y/ sae-ems
Openings Sealed? Alittii
No Partial
LOCATIO(/SEPARATI l" : /
Foundation to T an4\ kx-,-sD`• feet
Foundation to Absorption to ' feet FA-4
Separation of Pits >>" — feet
Conforms as per P 1 o P1 an ( i) No
LOCATION OF SYSTEM1OW PROPERTY:
(circle one) /
ront - Rear - Le/ft Side - Right Side
' i .• e Front - Middle Rear
COMMENTS: //
2,1A,` ,/ v
x('J-v f rt,,, .
SYSTEM USE APPROVED: NO
Arrived:
Departed:
g Inspector
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RECEIVED
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1993
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----4 & CODE DEPT.