91-794 C +I-�TIFICA'PE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date November 8 19
This is to certify that work requested to be done as shown by Permit No. 91794
has been completed.
This structure may be used as a SEWAGE ALTERATION
Location 1380 BAY RD. _
Owner TRACY, PHOEBE
By Order of Town Board
TAX MAP NO. 23. -1-33 TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-794
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Phoebe Tracy c
•l
Upper OWNER of property located at U pp Bay Rd Street,Road or Ave.
in the Town of Queensbury,To Construct or place a New Septic System
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 1
Same
C
2. CONTRACTOR or BUILDER'S Name
Chris Crandal Exc. a
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
fD
'S
CC
5. ARCHITECT'S Address
C.
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
CD
7. PLANS and Sp
ecifications
New Septic System to include: 1000 Gal Tank with 250' of Tile Field
No-using 12 stone, 1' Thickness as per plot plan specifications and -,
anpplication
8. Proposed Use
New Septic System
CD
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES November 12, 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 12th Day of 4 NOvember 19 91
SIGNED BY %,� for the Town of Queensbury
Building and Zoning' ryspector
;11
1 TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # °/ Y7179
Fee Paid aL S, G?
Date: f/ $ 9/ Reviewed By
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LOCATION OF PROPERTY FOR INSTALLATION: 3 3. --/ --`�
Owner's Name: IP/AAF,B,F '/—A;7/1G-
Owner' s Mailing Address: t,
Installer' s Name: cAeLS (i2c t �E C.. Phone #:
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150- gal . per bedroom): Y.3-0
Topography-Circle One: Flat C oolHn g_2) Steep Slope % of Slope
Soil Nature-Circle One: San Loa Clay Other /Depth:
Ground Water-At What Depth? /1//i Feet
Bedrock or Impervious Material-At What Depth? &y,(1"du,,...,, Feet
Percolation Test-Circle One: Not Required Required/Rate ��Mi��n. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other (it/G/1//
If'domestic water supply is a well -
Separation: Water supply from any septic absorption ,500 ''` feet
PROPOSED SYSTEM: Septic Tank /00 O gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench 4pro feet//Total System Length Z5 9 feet
Seepage Pit(s): Number of / Size each:
Size of Stone to be used: # ;2, / 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: DATE: /i/b/F7
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:
-Awn of Queenilur y '
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
.i'
NAME P \-\
LOCATION QN CR
DATE 1! / PERMIT NO. 9 / --'7c Li
SOIL TYPE - Sand - oa ! Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length ,?212
Length of each trench s' '
Depth of trenches 4 _ i
Size of gravel_
SEEPAGE PITS4N I.- of)
Size- ft. X ft.
Gravel size
PIPING: Size Type
Bldg. to tank y 5ck
Tank to dist. b.x
Dist. box to f eld/r• if S f0
Openings seal:.? NO Partial
LOCATION/SE:,RATIONS:\',
Foundation ' o tank
Foundation to absorption ...162 ft.
Absorption to lot line 1 ft.
Separation of pits
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side 'fight side ,
COMMENTS:
000144 (AP 0/1 r I r Q c ei,77
Ow e (4* fo P.sc h v
--t w:I 1/1)/ /
Cr?? s, -
41,
SYSTEM USE APPROVE11J0
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B F r, i W. Inspector
01/86 and vl
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