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1993-141 T ` 6 CE t TIFIC .T COMPLIANCE , t TOWN N OF QUEE VSBUR tl W ,..RREN COUNTY, NEW YORK - Date —A/au % 19 g3 1 This is to certify that work requested to be done as shown by Permit No. n,3-1.yl has been completed. i f This structure may be used as a SEP-nc 5y5TM Location , 7 MEaI O W Ae. Owner 1?IeI1Rk• . }rIPoIb By Order of Town Board TOWN OF QUEENSBURY Director of Building & Code Enforcement X BUILDING PERMIT TOWN OF QUEENSBURY No. g I WARREN COUNTY, NEW YORK a PERMISSION is hereby granted to ROH A RI) 5PrJFDR- OWNER of property located at 7 NI FR417 IN DR. Street, Road or Ave. in the Town of Queensbury,To Construct or place a S&PTIC ALT (c/}-'r1D/V 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. 7 1. OWNER'S Address is Some ,c 7 2. CONTRACTOR or BUILDER'S Name c n i tcry &wer Svce, 3. CONTRACTOR or BUILDER'S Address Po 8x22►1 Clerk Falls r y l zSo l 4. ARCHITECT'S Name 5. ARCHITECT'S Address 6. TYPE of Construction— (Please indicate by X) ( 1 Wood Frame ( ) Masonry ( )Steel ( ) I, 7. PLANS and Specifications SEPTIC AL PA110n( INCL(,1z7€ 25-0 FEES OF TILE No. f}-1- 50 F LENCLT74,5 W171+ kk 2 s—OA/ PI-T I Fr.- b PT7 /S PER _ P 1.Or"PLOW A-N AA-P P L►c�Tl ON, 8. Proposed Use SEPTIC- 5NISTn1 c r $ �.5.00 PERMIT FEE PAID —THIS PERMIT EXPIRES PR IL 28 19 95 (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 Day PR II--- 19 CZ3 SIGNED BY for the Town of Queensbury Building and Zoning In or .y' TOWN OF QUEENSBURY APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # __9 Fee Paid .� Date: • Reviewed fnECEIVED LOCATION OF PROPERTY FOR INSTALLATIOPR k)199 Owner' s Name: I&h -r1) /9- N/oV Owner's Mailing Address: 7 R, 3 Dec Installer' s Name: (.4N 446.),-/ Phone #: Number of bedrooms (if residential ) : r • Total daily flow (residential-compute @ 150 gal . per bedroom) : 6' 0 0 Topography-Circle One: Flat Rollin.' Steep Slope % of Slope Soil Nature-Circle One: Sand Loam Clay Other /Depth: Ground Water-At What Depth? Feet Bedrock or Impervious Material-At What Depth? Feet Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch Domestic Water Supply-Circle One: - Municipal Well Other If domestic water supply is a� - - Separation: Water supply from any septic absorption feet PROPOSED SYSTEM: Septic Tank JOOO gal . (Minimum size: 1,000 gal . ) Tile Field: Each Trench 67b feet//Total System Length 4451D feet Seepage Pit(s) : Number of / Size each: ft. x ft. Size of Stone to be used: # 2,- / Depth or Thickness I. feet ************** HOLDING TANK SYSTEM IF REQUIRED No. of Tanks Size\of Each Gal . ATarm 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 Town of Quee ury Sanitary Sewage Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON: DATE: ': r V 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: 0 e- & TWIN OF QUEENSBURY /L GLr- BUILDING Si CODE ENFORCEMENT 531 Bay Road Queensbury PAY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name i G� Location Date , Permit # /3-'/4/ SOIL TY E: Sand oam Clay- Results of Percolation Test- /' (if applicable) Rate-(Minute/Inh TYPE OF SYSTEM: / ABSORPTION FIELD: Total Length 250 Length of each trench\ 50/ Depth of trenches -4y' "/ Size of stone SEEPAGE PITS: Number- 1/ Size - ft. Stone size f ' PIPING: Size Type Bldg. to Tank �Kc�rr vG Tank to Dist. Box S i_ _11- Dist. Box to Field/Pit cy Openings Sealed? )Yes N'o Partial LOCATION/SEPARATIONS: Foundation to Tank, Akt5Tr:</Co feet Foundation to Absorption _c7k feet Separation of Pits ©r6_ feet Conforms as per ;O i ct Plan Yes No LOCATION OF SYSTEM ON PROPERTY: \ (circle one) ►-rbn - Rear -r+Left Side - Right Side Middle Front -;! Middle Rear COM ENTS Cop i rei -CTo2 f26-pA-r 20-0 TO P-, DwnJ n- 1s .4oUis 1/1-T". SCPT/L- TA-.UIC 5IFouLD & 2/ Oj/Fc6-4D /6 of /� �� r Ls, qx.,-76Ac4-orz_ Gu-,L.L._ 6c2.6“... (s) SYSTEM USE APPROVED: 420 NO Arrived: 10%5- • Departed: ) c Building Insp to . . . . .. . ,.. 4-'-- - ' _ _ _ -• - - - - • > 0 7\ t \ -i DiLk.,-,.._,, „ • Tow:1 C QuFED,IsouRY BunTA ,:G :,. -'o ; DEPT. REVIEWED BY DATE Fi