93-664 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date ' 'ey i1-. ..S 19
This is to certify that work requested to be done as shown by Permit No. 93-66 4
has been completed.
This structure may be used as a septic system
Location Fernwood Road
Owner C. Roger Gilbert
43-2-7
By Order of Town Board .
TOWN F QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY r
No. 93-664 'b
WARREN COUNTY, NEW YORK o
PERMISSION is hereby granted to C. ROGER GILBERT ,A
w
OWNER of property located at Fernwood 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. G�
1. OWNER'S Address is W
same
H
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2. CONTRACTOR or BUILDERS Name .
Condon' s Septic & Drain Svce
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LQ
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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)
( 1 Wood Frame ( ) Masonry ( )Steel ( ) O
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7. PLANS and Specifications 7:1
Septic alteration to include two 8 'x8 ' seepage pits o,
No. with #2 stone at 2 ft as per plot plan, and application.
8. Proposed Use
Septic system
CD
$ 25 . 00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 27 1995
(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.) �y
F-'
Dated at the Town of Queensbury this 2 7 th ay of 0 tuber 19 93
(1-
SIGNED BY for the Town of Queensbury H-
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Building and oning In or
s2Gx 8
aizzi TOWN OF QUEENSBURY � -'�` •
APPLICATION FOR SEPTIC DISPOSAL PERMIT 4y rmq t #
N Q 'e Taid ( ov
Receivedow Woof
Date: 0 ^ a 7 I as 1140 B
id&
LOCATION OF PROPERTY FOR INSTALLATION: _ _/U W O p d ti5)
Owner's Name: PO
Esz.. C-3/ NEA
Owner's Mail ing Address: tC,2/U w( a JkID ,L rakE cot9amasu,,;
Installer's Name: Cinitgiu Ser-e it_ -f21.(/J Phone #: 79P- 1f-'YZ
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom): 475 6
Topography-Circle One: O Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other COR__ /Depth:
Ground Water-At What Depth? MI � Feet
Bedrock or Impervious Material-At What Depth? /7//// - Feet
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipalalp Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption Ara feet
PROPOSED SYSTEM: Septic Tank a6 p a gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s): Number of / Size each: g ft. x g ft.
Size of Stone to be used: # 2' / Depth or Thickness 'Z,— 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. b , . t
/
SIGNATURE OF RESPONSIBLE PERSON: ,?, CAnd,e1,,-- ,_ C�DATE: - � 7 - 3
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ( /bo,k
Location t4e,„„,,i9Date /U/ Permit # 93-66 Y
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch A//-
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length AA
Length of each trench ,,,A
Depth of trenches
Size of stone I
SEEPAGE PITS: Numb‘r-
Size - V,/ ft. * P ft.
Stone size
PIPING: Size T
Bldg. to Tank 4 a1 /t(S-6 9
Tank to Dist. Box F cesL
Dist. Box to Field Pit ' ACC ye,
Openings Sealed? No Partial
LOCATION/SEPAR, TT S:;
Foundation to Tank / ,,,,/, feet
Foundation to Absolrption AA feet
Separation of Pit _ye fee
Conforms as per Pi4Dt Plan Yes ad
LOCATION OF SYS ON PROPERTY:
(circle •• -.L
'p
Front 'ea - , Si - Right Side
Middle rout Mi e Rear
COMMENTS: /
/ 647- a
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64;r'///
s-th",, "44., .Z.-)I1,A1‘;` -A-4 /;(*(4--
SYSTEM USE APPROVED: � & 4N IT/e//s
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NO
Arrived: /,yv
Departed: /Zo
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