93-702 t• �
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 90,177 19 9%
This is to certify that work requested to be done as shown by Permit No. 93-702
has been completed.
This structure may be used as a sep`1; system
Location Jay Road
Owner Jean Lauroesch
13-1-14
By Order of Town Board
TOWN OF QUEENSBURY
Director of Buildini & Code Enforcement
1
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 93-702
WARREN COUNTY, NEW YORK ' p
PERMISSION is hereby granted to JEAN LAUROESCH
OWNER of property located at Jay Road 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
O
LTJ
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(-)
2. CONTRACTOR or BUILDER'S Name
Wayne Underwood (1)
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
0
sy
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
Septic Alteration to include pump chamber, 1000 gallon
No. septic tank and two 8 ' x8 ' seepage pits as per plot plan
and appl i r,ai-i nn
8. Proposed Use
Cn
Septic system ro
n
25 . 00 November 18 95
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
rt-
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the n
town of Queensbury before the expiration date.)
H.
rt
18th Nov er 93 0
Dated at the Town of Queensbury this of 19 O
SIGNED BY for the Town of Queensbury
Building and Zoning In ct
TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT• ; )� Permit #
R Fee Paid
y �Q3
Date: l/�/ 1 p�eG���po a Rev�r,•wed By
LOCATION OF PROPERTY FOR INSTALLATION: MT sr' s� ��°> , tY
Owner' s Name: t �Q � �►a .��: „ L-;� 4° ./. . . '4.
Owner's Mailing Address: .1v1 ,
Installer' s Name: C9 � 9,,`�Af ,(00.0� Phone #: sTSY("M4'
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom): y5
a
Topography-Circle One: Flat Rom Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay OtherarnVe -- /Depth:
Ground Water-At What Depth? r o Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: tot Requir 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 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 REQUIRE
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: l.(I ` ATE: /7
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 Enfo:°cement
Department
531 Bay Road
Queensbury NY 12804
Remarks:
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own of Queen Jur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME , ' (.. q G g'
•
LOCATION , \ I ; 2
DATE //3 Q/PERM IT f�0. Q3 40 ,
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
T •
Absorption field, total lengt r-,
each trench/i ; (. -, r
Depth of trenches
Size of gravel_ `- _
SEEPAGE PITS{Numbe' of) -
Size- ft. X r -'
Grave ,---`
PIPING: f Size Type
Bldg. to tank!
Tank to dist,/ box sc)}''?--3
Dist. box to. field/pit '3'ynk_ 3 c
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption ft.
Absorption to lot line ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS:
.S eTk C B E-1-3 PR dEPATLe n
e fk- )Z E- A) 6 I AJ. -4 e--3 C6c- - —
SYSTEM USE APPROVED YE: g
Al
Bu''- ding nsrector
01/86 and vl '''2„r i ()
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TOWN OF QUEENSBURY ' �
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
patttai
Name 4./4
Location _ 21,4/ led
Date 124A j Permit # 93_ 70 2-.--.
SOIL TYPE: P oam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch A.,/-
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length Alf
Length of each trench
Depth of trenches /11/A
Size of stone
SEEPAGE PITS: Number- 2i
Size - ft. x Y ft.
Stone size
PIPING: 'ize Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pig; z/° SMC
Openings Sealed? Warp No Partial
LOCATION/SEPARATIONS:
Foundation to Tank /00 feet
Foundation to Absorptin de feet
Separation of Pits ' .a v' feet
Conforms as per Plot Pl'an Yes
LOCATION OF SYSTEM ON PROPERTY:
(circle o• - ..
Front - 'ear Left Side - Right Side
Middle ront - Middl Rear .
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrived: 11 Sf—
Departed: 12'/S
Building In ec r
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WARREN CGUNTYI NEW PORK
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i' TOWN OF QUEFNB� f�Y, AUG.----- w 1 P'. 1 — ,,1 1U 1 G 7, 1990.