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1993-142 • • •• CERTIFICATE .1-F COMPLIANCE w_. • TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date . I 19 �,3 This is to certify that work requested to be done as shown by Permit No. q3-f'42._ has been completed. This structure may be used as a P{-��r S yJc err, . Location }�i c _vcESc�7, SfrP�t- Owner DAY 14R2146 T-6W _. I I_ 5_ j8 By Order of Town Board TOWN OF QUEENSBURY • Director of Building St Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY 'I No. C] '1 402 WARREN COUNTY, NEW YORK (J' UI PERMISSION is hereby granted to Diw►b 14/ PRI PI Cc 77)N OWNER of property located at RIC /-/iR77SAi Sr Street, Road or Ave. in the Town of Queensbury,To Construct or place a SEPTIC /4-LTEAT?Oly 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 'RD 4 r3X 54 b 4y RD 4ue.m-B ie ty I2q z 2. CONTRACTOR or BUILDER'S Name SA-Ai 17/C1-2J SEWEe ,5`IV rJ 3. CONTRACTOR or BUILDER'S Address PD Bx Z. GLE1vs r4u$ N/ iz80 / 4. ARCHITECT'S Name 5. ARCHITECT'S Address r� 6. TYPE of Construction—(Please indicate by X) II ( )Wood Frame ( ) Masonry ( )Steel ( ) c 7. PLANS and Specifications e55T7 H lC i )eATz©nl T i n(cu- 2- 8'X8'dEEA9C�e pi r5/ No. WI rH !13 5i € /1X ;2, 1, ' D..E'PT7f R5 P..4 -PLDr f A &i'v r) /*PPL i CA-Ton/ 8. Proposed Use EP77C s)/ m PERMIT FEE PAID —THIS PERMIT EXPIRES (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.) 1�-( Y-1 Dated at the Town of Queensbury this Day of P./E.- 19 Q� SIGNED BY for the Town of Queensbury Building and Zoning In r -5—/f A OP USENSE3 . . _ RECEIVD tt� 11 j TOWN OF QUEENSBURY 9 1 APPLICATION FOR SEPTIC DISPOSAL PERMIT APR �� �#mit # Fee Paid ,S r 1r qEOA.MDEFT. Date: 2/"' 2-z -/ 9 y3 Reviewed By LOCATION OF PROPERTY FOR INSTALLATION: Owner' s Name: r:DAU t, 0 H-ft k tu Owner' s Mailing Address D Jig 05( ��} i / 4r y /t9 Installer' s Name: AA/i 7F/'z-:p.A` (- Phone #: %9z-7 7 Number of bedrooms (if residential ) : Total daily flow (residential-compute @ 150 gal . per bedroom) : gc5-0 Topography-Circle One: ' Rolling 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: of Required Required/Rate Min. Per Inch Domestic Water Supply-Circle One: Aga, Well Other If domestic water supply is a `ai - Separation: Water supply from any septic absorption feet (ft14-rtA)(.) PROPOSED SYSTEM: Septic Tank I On gal . (Minimum size: 1,000 gal . ) Tile Field: Each Trench feet//Total System Length feet Seepage Pit(s) : Number of 1/ / Size each: R ft. x ft. 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 Town of Queensbury Sanitary Sewage Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON: apA1A DATE: P 130 �1 1- 15 1 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 $250.00. C. An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installation, alteration or repair of an approved system, a new proposal must be submitted to the Queensbury Building Department before further construction. Town of Queensbury Building & Code Enforcement Department 531 Bay Road Queensbury NY 12804 Remarks: TOMM .OF QUEEWSBURY ',BUILDING A CODE ENFORCEMENT ` 531 Bay Road 477 Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name Ø'2/H;', �l Location Date .0 iL3 Permit # SOIL TYPE: Sand-Loam-Clay- i Results of Percollati on' Test- (if applicable) .Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length Length of each trench Depth of trenches Size of stone SEEPAGE PITS: Number- ,. Size - 8 ft. x6 ft. Stone size 4y. ;:ry \ PIPING: +' Size Type Bldg. to Tank rv4g4 — Tank to Dist. B1ox s �$ Dist. Box to Feld/Pit , , y Openings Sealed? No Partial LOCATI ON/SEPARATI C S: Foundation tolank ex7s1- feet Foundation to Absorption '0,7 feet Separation of Pits feet Conforms as per Plot Plan rr`,dYes No LOCATION OF SYSTEM ON PROPER : (circle one) Front ej ' Left Side - Right Side Middle Front - Middle Rear COMMENTS: - I?u SYSTEM USE APPROVED: NO Arrived: 40 Departed:`) "55 ' Aing Inspector 7-; -1 •"-7.-P il .--- .........2, C...)... \e/ 10 Tc k• AC' % C.) . ....f- (, < y o 41 a 0! 0 - -- u S. _ NI x v ,..... 0 ..-\ -6 0 Z) 1 c.,) t a k (' L3 0 T 0'1!H 0 F Q U E rE i',2 5 El U n, V 6 u _D E.,z,frz REVIEWED EY DATE 4 f r