1991-809 T:ice, i.
�T°t�al3t_ - .F'ti'• .� t._�..,`'ram.�"h Y� .
Itee, Ave,
•
b�s,i aR ^
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date //rr71.1, ./ef 19 9/
This is to certify that work requested to be done as shown by Permit No. 91-809
has been completed.
This structure may be occupied as a Septic Alteration
Location Bx 79 Star Rt
Owner Gary Mattison
By Order Town Board
TOWN OF QUEENSBURY
1'I r l�J,r
v
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-809 'a
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Gary Mattison
F--�
OWNER of property located at Bx 79 Star Rt 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 c+
rt
Same H'
0
2. CONTRACTOR or BUILDER'S Name pWi
Walt Stevenson 4c
3. CONTRACTOR or BUILDER'S Address
X
(/)
4. ARCHITECT'S Name �.
e-1
5. ARCHITECT'S Address
C/Y
rt
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
CD
7. PLANS and Specifications
z.
No. Septic Alteration to include: 200' of Tile Field using #2 Stone =
1' Thickness as per plot plan specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID—THIS PERMIT EXPIRES November 14, 19 93
(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 14th Day f November 19 91
SIGNED BY for the Town of Queensbury
Building and Zoning In ctor
3## . • -
T
WN
RY
� APPLICATION FOR SOEPTIOCF D SPdS ILU bE 1 t lSBL. Fermi t # 14oq
"'fVED Fee Paid5, '5
°'5V 1 3 1991 ��
Date: rr� ( Reviewed By 4//,/.
F'". _ c�,00 DEPT.V, AfD of k4 t ' av°��
LOCATION OF PROPERTY FOR INSTALLATION: Ii`DG
Owner' s Name: 7/, 4/F4
f j 5 i 'V /� OA
• Owner' s Mailing Address: lel 5- E2- . 1i An1I La.12/Al
L
Installer's Name: WA-LA- Phone #:
Number of bedrooms (if residential ):Total daily flow (residential-compute @ 150-gal . per bedroom): , gC
Topography-Circle One: Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth:
Ground Water-At What Depth? f, '. p P 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 -Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption / 9 feet
,
PROPOSED SYSTEM: Septic Tank , 5/1 . (Minimum size: 1,000 gal . )
Tile Field: Each Trench y ( feet//Total System Length ,d 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: A DATE: /1//6
Jown of Queen3ur1
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAMEATA6-Solof
LOCATION aTEC-NT.,u)ccup
DATE i(J / (I( PERMIT NO. qj-- D61
SOIL TYPE - Sand -(Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length zoo
Length of each trench"r 57-(t)
Depth of trenches,
Size of gravel Za _
SEEPAGE PITS{Number of)_,...�
Size- X ---fa.: �adm• "
Gravel size "�•"
PIPING: Size Type
Bldg. to tank X.5 -cl,lCC .--
Tank to dist. box °a£(. Pvc—
Dist. box to field/ it, ' '-( �°�re=—
Openings sealed? YESa� NO Partial
LOCATION/SEPARATIONS ` 1•
Foundation to tank/ f
Foundation to abso ption ' f
Absorption to lob line ;'; ft
Separation of pits ,4 ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - e , Left side -<Rgh -t s 0 -
COMMENTS
C6i2T12-1A 1,A-20 Nit de-
SYSTEM USE APPROVED 9557' NO
Building` In,pector
01/86 and vl
- - - -R ___ - 't,VED -
f=` W 1 3 1991 ,�,
o ®
F Da. & COD D )
47
b c \\ 'd
J� t
c
`) -- -
0 1
ili ��/ b� "r
,., _cf._
ff) 1 Dec-'
/0 0 t- - - 1
0 ''')( - 1
/ 'I
5 P-7- --