92-778 y ,
f • ..9M CERTIFICATE OF COMPLIANCE
ANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date "V-/.(iin lv /4/ 19 992
This is to certify that work requested to be done as shown by Permit No. 92-778
has been completed.
This structure may be used as a septic system
Location Warren Lane
Owner Michael R. LeBlanc
121-6-32 By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY z
No. 92-778
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to MICHAEL R. LeBLANC °1
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OWNER of property located at Warren Lane 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
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same RD#3 Box 231
2. CONTRACTOR or BUILDER'S Name
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3. CONTRACTOR or BUILDER'S Address —'
4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction— (Please indicate by X) r—
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( ) Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No Septic alteration to include two 6'x8' seepage pits with #3 stone
as per plot plan, specifications and application.
8. Proposed Use _
Septic alteration
for septic system
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES December 10 19 94 a)
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
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town of Queensbury before the expiration date.) -5
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Dated at the Town of Queensbury this 10th Day of December 19 92 0
SIGNED BY for the Town of Queensbury
Building and Zoning In ctor
jj �y ` vw�1 OF 1.�EENSbL.
RPCEIVED
5013R
VE APPLICATION FOR SOEPTIOCF DISPOSAL PERMIT L EC 1 [44i t # 67)
Fee Paid
^G. & CODE DEFT
Date: / - 9') Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: kJ-m 'ef'f G�oeei2slv,47y
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Owner' s Name: /7,/1/)L;i Li 4 . /6
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Owner' s Mailing Address: 96 3 1�OX 0 -3/ ZdO L-Ail 1_72i7e_
Installer' s Name: / F Phone #: `7%or7-43/7
Number of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 gal . per bedroom) : 0
Topography-Circle One: Flat 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: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal ' Well Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank (. 5 hi _ 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 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: 7 4 ,//(' ,, � -- DATE: /„ /G) - ��
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 $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
Town of Queensbury
Building & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks:
TOWS 07
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REVIEWED BY i .e-------
DATE /07:F.1.,11
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i ,vr4 OF QUEENSbk-
\ RECEIVED
C78E CODE 0
C131992
G. EPT
.own o1 QueenJbur -
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BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
SEPTIC
E��/L �1iMiaeLPPTIC DISPOSALSYSTEM INSPECTION
NE "` l' 1__e( )I Cc ii C�
LOCATION L3 o
Wr l`ve.t- pZO-A-st_ �.
DATE l :)-/ ) PERMIT NO. (i -17V
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SOIL TYPE - ($an � Loam - Clay -
Percolation Test Required? YES - Oj
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches .;_ -1--
Size of gravel
SEEPAGE PITS4Number of)
Size- ft. X _53- ft.
Gravel size -tE- .. •- tt
-
PIPING: Size Type
Bldg. to tank ')(( 1-- ,(,!(_,
Tank to dist. box L. 7)(
Dist. box to field/pit =1 PVC.-
Openings sealed? (igS. . NO Partial
LOCATION/SEPARATIONS:
F - _ - t. A,..„ 'a,it-
Foundation to absorption ft.l g r p(A,L)
Absorption to lot line ft. V1-
0
Separation of pits ; ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rea - Left side - Right side -
COMMENTS:
eXAMillt 15 /\ u(sz- fl\f-o .-a--
I?) A.F. p,•.-.''L.g.: i Ait 1,7't 6 PA1C 1 it AdK •
SYSTEM USE APPROVED YE 4 NO
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Building I pector
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