93-241 le
s.-,mil; s.
- CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 7114ty �7 19 Y
This is to certify that work requested to be done as shown by Permit No. 93-241_
has been completed.
This structure may be used as a stptic system
Location 1876 Glen Lake Road
Owner Earl. Spellburg
36-1-16
By Order of Town Board
OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT 1-3
TOWN OF QUEENSBURY No. 93-241
WARREN COUNTY, NEW YORK ro
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PERMISSION is hereby granted to Earl Spellburg
OWNER of property located at 1876 Glen Lake Road Street,Road or Ave. rn
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
same
Lake George NY 12845 ro
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2. CONTRACTOR or BUILDERS Name ti
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Queensbury Sewer Service
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
5. ARCHITECT'S Address I-,
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6. TYPE of Construction—(Please indicate by X)
( 1 Wood Frame ( ) Masonry ( 1 Steel ( ) ♦
7. PLANS and Specifications
Septic alteration to include 100 Ogallon septic tank only
Nis per plot plan and application. sz
8. Proposed Use
Septic system ro
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25 .00
$ PERMIT FEE PAID —THIS PERMIT EXPIRES MAY 26 1995
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the I•"�
town of Queensbury before the expiration date.) rh
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Dated at the Town of Queensbury this 2 6 th Day of 19 93 rt
SIGNED BY for the Town of Queensbury
Building and oning In or
is*, TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
Fee Paid
Date: > ' T7 7 _ Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: 0.;024 252
Owner's Name: /' T r ( p' / /d e c- - Wry n
Owner's Mailing Address: / r 7 6 Re t .
Installer's Name: d�d.f c%5 �s e r e G
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom): v Z1
Topography-Circle One: (/Flats Rolling Steep Slope % of Slope
Soil Nature-Circle One: and) Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: of Requi er d) Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal ell ther
If domestic water supply is a well -
Separation: Water supply from any septic absorption / ' ,feet
PROPOSED SYSTEM: Septic Tank/ (Y—t)(_) gal . (M. imum 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: DATE: '6 - r -3
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.
L . Should unforeseen problems during construction prevent proper installation,
alteration or repair .of an approved system, a new proposal must be submitted
tc the Queensbury Building Department before further construction.
Town of Queensbury
Building & Code Enforcemen':
Department
531 Bay Road
Queensbury NY 12804
TOWN OF QUEENSBURY ICE- 3c=
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name F?.fi �.4a
Location LSI/& ion 42161 eat
Date 42/43 Permit # 93 -,4{t
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS'
Foundation to Tank
feet
Foundation to Absorption feet
Separation of Pits _ feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - deft Side - Right Side
Middle Front -;Middle Rear
COMMENTS: ' GSA'
f , /va'GS '
1111
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SYSTEM USE APPROVED: YES NO
Arrived:
Departed:
Buildin ector
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