1992-045 r
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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date .'tid/Ala}r—eu // 19 9.�.
This is to certify that work requested to be done as shown by Permit No. 92-045
has been completed.
This structure may be occupied as a Septic Alteration
Location Columbia Avenue
Owner Veronica Kingsley
By Order Town Board
TOWN OF QUEENSBURY
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Director of Bldg. & Code Enforcement
BUILDING PERMIT •
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TOWN OF QUEENSBURY
No. 92-045
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Veronica' Kingsley
OWNER of property located at Columbia Avenue 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. ='
to
1. OWNER'S Address is .-.r
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Same
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ID
2. CONTRACTOR or BUI LDER'S Name.-
T. Fortino Excavating
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( 1 Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications fD
Septic Alteration to include: et
No. 1000 gal Tank with 1 seepage pit, 8' x 10' using #3 stone, c
8. Proposed Use
Septic Alteration
• $ 25.00 PERMIT FEE PAID—THIS PERMIT EXPIRES February 11, 19 94
(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 thiis . 11th Day of , February 19 92
SIGNED BY ) for the Town of Queensbury
Building and Zonin4nspector
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TOWN OF�_,,Q�UEENSBURY/
APPLICATION FOR -§P COWI E'A,: :,_:!°.,.`VT Permit # c/.2_--041j
R CEIV'ED Fee Paid C
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Date: P�,�,�r, Reviewed B
LOCATION OF PROPERTY FOR INSTALL: & gam;D�� ,� ,�. i,,,�e
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Owner' s Name: 1GPrr rficp. kints,9Z i
Owner' s Mailing Address: re, Lug , 4, . 19
Installer's Name: ~
1 r ��- ��_'°��,�}.<iep-v,..0-b.ivj Phone #:
Number of bedrooms (if residential ): ONE
Total daily flow (residential-compute @ 150 gal . per bedroom) : /j)
y
Topography-Circle One: Flat dying Steep Slope S% of Slope
Soil Nature-Circle One: S n Loam Clay Other /Depth:
Ground Water-At What Depth? p ace Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
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Domestic Water Supply-Circle One: MIRO Well Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank ), (p() gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s): Number of / , / Size each: ft. x 16 ft.
Size of Stone to be used: # / Depth or Thickness ► '2eet
**************
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 th Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: DATE: io 1`Z
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
- ---'- 6-.- -- No -system-shall -be- covered before inspection- and approval by- the Building ---
Inspector. ---- --
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 "5ri
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:
.4, _-
70-
606
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TOWN OF QUEEN4tutiv
RECEIVED
FEB I 1992 TOWN OF QUEENSBURY
BLDG. & CODE DEpT BUILDING • ( DEPT.
REVIEWED BY
DATE
Or" C& L-Ne0- AN.cl,.,130.4: 7-
. awn ol, Queenst ury . . . \
BUILDINCFand ZONING DEPARTMENT. .
Bay and Haviland Road, R.D. 1 Box 98 - . \
Queensbury, New York 12801
1
SEPTIC DISPOSAL SYSTEM INSPECTION
NAMEV.--.0k A- SI-et . �ev r I'ceA__ • • :, \
LOCATION 0_0lt n ,\ 1 •
DATE c //I/ PERMIT NO. 9 , 04
SOIL TYPE l Sa - 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 PITS4Nuinber of) -
Size- - ft. .x /d ft. .
Gravel size
PIPING: Size
Bldg. to tank ii P7A , : .
Tank to dist. box c/ '" ' i°dV
Dist. box to field/pit
Openings sealed? YES lid Partial
LOCATION/SEPARATIONS: '
Foundation to tank\ ft.
Foundation to absor.t l n �ft. • .
Absorption to lot li e �6 ft.
Separation of pits ft.
vmm..!.2 TION OF SYSTEM ON PROPERTY.f circle one)
‘g74?i, - Rear - Left j si e - Right side -
COMMENTS:
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SYSTEM USE APPROVED YE NO
Buil ing Insp ctor
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TOWN OF QUEENSBURV
RECEIVED
FEB 1 0 1992
BLDG. & CODE DEPT.