1992-163 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY .
WARREN COUNTY, NEW YORK
Datc 19
This is to certify that work requested to be done as shown by Permit No. 92-163
has been completed.
This structure may be occupied as a Septic Alteration
Location Knoll Rd North
Owner Francis & Nancy McKeon
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 92-163 �
WARREN COUNTY, NEW YORK
r
PERMISSION is hereby granted to Francis A Nancy McKeon
M
Knolls Rd North F
OWNER of property located at 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 <
V
2. CONTRACTOR or BUILDER'S Name C
f
Hometown Sewer
s
3. CONTRACTOR or BUILDER'S Address
f
V
4. ARCHITECT'S Name
2
C
5. ARCHITECT'S Address
to
7
C
6. TYPE of Construction— (Please indicate by X)
e
( ) Wood Frame ( 1 Masonry ( ) Steel ( )
7. PLANS and Specifications
No. Septic Alteration to include: 330 ft of Tile Field using #2 Stone z
2' Thickness as per plot plan specifications and application
B. Proposed Use
2
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 21, 199_
(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 Z 1s-t D of April 19 92
SIGNED BY for the Town of Queensbury
Building and Zoni nspector
3-
TOWN OF QUEENSBURY /-
APPLICATION FOR SEP4QV19Ic5 EP4% ITPermit #
fiECE1VEp Ui' Fee Paid cjv
Date: /y,, APR 2 0 1992 Reviewed By
LOCATION OF PROPERTY FOR INSTALLATf". $ CabE4Dd�,/�c�_
Owner' s Name: 44 �rctn n
Owner' s Mailing Address:
Installer' s Name: �f� � �nc�,�, S^.�cy er Phone #:
Number of bedrooms (if residential ) : Gf
Total daily flow (residential-compute @ 150 gal . per bedroom) :
Topography-Circle One:6
Rolling Steep Slope q 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 el Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption Z23' feet
PROPOSED SYSTEM: Septic Tank gal . (Minimum size: 000 gal . ) 3-30
Tile Field: Each Trench _ 570 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 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 the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: DATE: a
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Down o f QueenAury "C01%'eV�
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME 0 2r��
LOCATION
DATE l[/ /�1 PERMIT NO. ( (!r?
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches
Size of gravel_ _
SEEPAGE PITS{Number of)
Size- ft. X _ ft.
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box _
Dist. box to field/pit - --
Openings sealed? YES # NO Partial
3
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption ': ft.
Absorption to lot line k ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROIERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS:
a
Piet- rRo C(1
S L
SYSTEM USE APPROVED YES NO
i
Y
Bui ding Inspector
01/86 and vl
eeNN
Jocun 0/ Queenigury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury,,�New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION_
DATE 'ifo wZ/ PERMIT NO.
SOIL TYPE - Sand - Loam -,
Cla t
Percolation Test Required? .- NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length > �'
Length of each trench
Depth of trenches „?
Size of gravel_ 2,
SEEPAGE PITS{Number of)
Size- ft. X ft
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box - ~
, �' ,<
Dist. box to field/ .
Openings sealed? ES�� NO Partial
LOCATION/SEPARATIONS +a '
Foundation to tank ft.
Foundation to absorpt'o . e 'ft.
Absorption to lot linp ft.
Separation of pits /— ft.
LOCATION OF_SYSTEM ON PROPERTY(circle one)
Front - Re/- Left side - Right side -
COMMENTS:
Illew
SYSTEM USE APPROVED YES NO\\
Building Inspector
01/86 and vl
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
41 STATE STREET,ALBANY,NEW YORK 12207
Date Application
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by named on the above application number in the premises of
in the following location; ❑ Basement ❑ lst Fl. ❑ 2nd Fl. Section Block Lot
was examined on and found to be in compliance with the requirements of this Board.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FAN
OUTLETS INCANDESCENT1 FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
DRYERS FURNACE MOTORS FIITURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS ULL UNIT HEATERS MULTI-OUTLET DIMMERS
OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. SYSTEMS AMT. WATTS
NO.OF FEET
SERVICE DISCONNECT NO.OF S E R V 1 C E
AMT. AMP. TYPE METER IA`2W 10 3W 3 p 3W 3,9 4W No.OF CC.COND. A.W.G. NO.OF HI-LEG A•W G. NO.OF NEUTRALS A.W.G.
EQUIP• PER Ir OF CC.COND. OF HI-LEG OF NEUTRAL
OTHER APPARATUS:
STACK HENSI,ER INC.
RCO2 BOX 90A _ �T
RIVER. RD. BRANCH MANAGER
WARRENSBUIRG, NY, 12885
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.