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CERTIFIC TE OF COMPLIANCE
TOWN- OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date M./.4/ 19 gi
This is to certify that work requested to be done as shown by Permit No. 91-360
has been completed.
This structure may be occupied as a Septic Alteration
Location RR2 Box 221, W. Mtn Rd
<'Owner Terry Noon
By. Order Town Board 1
"" TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
-
BUILDING PERMIT 3
TOWN OF QUEENSBURY 0
No. 91-360 a
WARREN COUNTY, NEW YORK a
'C
PERMISSION is hereby granted to Terry Moon
OWNER of property located at RR2 Box 221, West Mtn Rd Street, Road or Ave. CD
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 0
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
Same nN.
0
x
2. CONTRACTOR or BUILDER'S Name
F—
Y
Sanitary Sewer
CD
3. CONTRACTOR or BUILDER'S Address of
3
x
4. ARCHITECT'S Name
V
CD
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eh
0
5. ARCHITECT'S Address
eF
rD
e+
6. TYPE of Construction— (Please indicate by X) 0
( 1 Wood Frame ( ) Masonry ( )Steel ( ) _
7. PLANS and Specifications
Septic Alteration to include:
No. 1000 gal Tank with 1 seepage pit 10' x 8' using #3 Stone, 2' Thickness
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 29, 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 29th Day of / May 19 91
SIGNED BY C .I'.r'll for the Town of Queensbury
Building and Zoning In ctor
TO N OF QUEEN QL4L��
RECENED
41Vini APPLICATI' F. SE' C DISPOSAL PERMIT
MAY 2 81991 •
DATE: 3 — 9/
®G. CO 14K d
LOCATION OF PROPERTY FOR INSTALLATION WA:. 2 ( ut
Owner's Name: -e(Z,(t, 0OiJ
Address:. K R.. Z Q0 X as / 1& . Gar go
Installer' s Name: j14 /11c �vQ� Telephone: -79) - 7 as-2
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: Circle one Rolling Steep Slope % of Slope
Soil Nature: Circle one: Loam Clay Other /Depth: .
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what depth? . Feet
Percolation test: Circle one: t required required
Rate Min. Per Inch
Domestic water supply: Circle one: unici al Well Other
If domestic water supply is a we .
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank . j Ooo gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number, of ( /Size each ( 0 feet
by f> feet .
- Size of-stone-to-be- used-#-:_.. —"Depth or Thickness
P feet
*****************************
HOLDING. TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal .
*Alarm system and associated electrical work to be inspected by an approved
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: � 0 TE: Jf Yam mil(
1 ;
logic System Inspections: _ ..
A. All applications for septic system installation; alteration or repair,
as required by the-Town of Queensbury Sanitary Sewage Ordinance,: shall
by submitted co the Building Department at least 24 hours before start
oiconstruction -and shall include a plot plan: showing: � 4
1.) the proposed location of the system
2.) location and distance to lot lines
3.) location and distance co structures
4.) location and distance to any water supply
5.) size and dimensions of all tanks, distribution boxes,
cilr_fis1dsanJ/_or drywalls _ _
B. Nu system shall be covered before inspection and approval by the
Building Inspuctor. Failure to comply with this requirement may
result in the uncovering of chd system by the installer and a fine
of up co $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
rgsulc in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installa—
cion. alteration or rgpuir of an approved syites, a new proposal must
bu submitted co the Qu.:unsbury building Department before further
construction.
Town of Queenabury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
Rgmarks:
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awn of Queentur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801 ,
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME OM\ I e c
LOCATION r ( \k)CS- MI- 4-cu 1 1 eif V`(
DATE 5 /3/ PERMIT NO:1- _! �-31oO
SOIL TYPE Sand ' Loam ]Clay -
Percolation Test Required? YES N0
Percolation rate - Min/I•1ch _ I
/+
TYPE of SYSTEM: , /
Absorption field, total lei
Length of each t
Depth of ches n a
SI e of grave
SEEPAGE PITSf Number of), ' hi
Size- ft. X (p. ft. 1
Gravel size , .)
PIPING: S%ie Type
Bldg. to tank /�
Tank to dist. box !';1
-Dist. box to-field/.it1 1- --1 1/C- - - -
Openings sealed? ;” NO Partial
LOCATION/SEPARATIONS: (
Foundation to tank/
� ft.
Foundation to abso ptio 2G ft. '�
Absorption to lot line jLf t.
Separation of pits -
I ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Deft side\- Right side -
COMMENTS: _
\ .
SYSTEM USE APPROVED YES NO ,
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B.ilding Inspector
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