1994-248 CERTIFICArPE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date ��,,�,j 19
This is to certify that work requested to be done as shown by Permit No. 94—$46
has been completed.
This structure may be used as a -c :`'St'
Location 5 Knolls Road North
Owner F ranc is LcKeon
26-3-1 .i5
By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No 94-248
WARREN COUNTY, NEW YORK
FRANCIS McKEON 4%,
PERMISSION is hereby granted to +'
OWNER of property located at 5 Knolls Road North 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
2. CONTRACTOR or BUILDER'S Name
Hometown Sewer Svice
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction— (Please indicate by X)
( )Wood Frame ! ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. Septic alteration to include 1000 gallon septic tank only
as per plot plan and application.
8. Proposed Use
Septic system
$ 25 . 00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 3 1996
(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 3 r Day of une 19 94
( /)j -
SIGNED BY '--1 for the Town of Queensbury
Building a rang I or
�i
TOWN OF QUEENSBURV,-<-)
�
APPLICATION FOR SEPTIC DISPOSAL ,, M P it #
gLi�oZ/�
JUN 1994 Fe aid
Received N
Town of
Date: /f z Queensbu�Cevie By .
Bidg. Dept
LOCATION OF PROPERTY FOR INSTALLATION: rAZZf-,
Owner' s Name:
Owner' s Mailing Address:
Installer' s Name: ,,;� r,; 5 - le Phone #:
Number of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 gal . per bedroom) :
Topography-Circle One: , 1 Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam (fa:y> Other /Depth:
Ground Water-At What Depth? /c." Feet
Bedrock or Impervious Material-At What Depth? e�Z.,x," Feet
Percolation Test-Circle One: Not Required ' Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: unicipal Well Other _
If domestic water supply is a we -
Separation Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank &,00 _ gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s) : Number of / Size each: ft. x ft.
Size of Stone to be used: # % Depth or Thickness feet
**************
HOLDING TANK SYSTEM IF REQUIREp
No. of Tanks Size`of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
agency.
****************
1 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: a- riz �- DATE:
T
b
TC� a# QUEEN. BURY
13UILDI � SPT.
REVIEWED BY
DATE
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TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date x_6.2 Permi t
SOIL TYP Sand= oam-Clay-
a �
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 - — ft. ;x ft.
Stone size �—
PIPING: Size Ty e
Bldg. to Tank ,L�'F
Tank to Dist. Box � .
Dist. Box to Field/Pity
Openings Sealed? No Pa—rt-57
LOCATION/SEPARATIONS:
Foundation to Tank /P i(Z feet
Foundation to Absorp ion E? � ',,I fgt
Separation of Pits feet
Conforms as per Pi P1 an es o
fi
LOCATION OF SYSTE ON PRO ERTNU --
1..
(circle one)
Front - Rear - L t de 1= Right Side
Middle Front - ddl a Rear
COMMENTS:
a � erre ._
fJ�V�^J
. TAt�
SYSTEM USE APPROVED: YES
r €,
Arrived:
Departed:
Build' nspector
i r`r ia; i