94-722 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date December 28 , lg 94
This is to certify that work requested to be done as shown by Permit No.94-722
has been completed.
This structure may be used as a Septic Alteration
Location TeeHill Road
Owner Niel Muscatieuo, 7 McCormick Road, QueensburyMuNY 12804
By Order of Town Board
TOWN OF EENSBURY
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Director of Building & Code Enforcement
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BUILDING PERMIT
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TOWN OF QUEENSBURY No 94-722
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Neil Muscatiedo
OWNER of property located at Tee Hill Road Street, Road or Ave.
Septic Alteration
in the Town of Queensbury,To Construct or place a p m
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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. rt
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1. OWNER'S Address is
7 McCormick Rd
Queensbury, NY 12804 z
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2. CONTRACTOR or BUILDERS Name
Jay Sweet
3. CONTRACTOR or BUILDER'S Address 1-3
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4. ARCHITECT'S Name �.
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
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( )Wood Frame ( ) Masonry ( 1 Steel ( ) rt
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7. PLANS and Specifications P3
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No. Septic Alteration as per plot plan specifications
8. Proposed Use
Septic Alteration to include: 200 ' of tile field using #2 stone
12" Thickness
$ 25 .00 PERMIT FEE PAID —THIS PERMIT EXPIRES December 21 , 19 95
(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 21st Day If December 19 94
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SIGNED BY -WO for the Town of Queensbury
Building and Zoni'4nnspector
Prep,MIL
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� � TOWN OF QUEENSBURY an ( / �
APPLICATION FOR SEPTIC DISPOSAL PERMIT 1 fta: Permit #
�';eE,r�' ca> Fee Paidmot
1
Date: / _ 2 6 - eil Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: 7 . / tii/ 72es ct ,_I
Owner's Name: ' c_et ' - l„ ' (-- /IL S c'c'_ .f do
Owner's Mailing Address: 7 4/1 C r L 7
Installer's Name: L`ce. kiS A • e. „. Phone #: r"
Number of bedrooms (if residential ) : _ )
Total daily flow (residential-compute @ 150 gal . per bedroom):
Topography-Circle One: CFlat Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: of Re ui Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other _
If domestic water supply is well
Separation: Water supply from any septic absorption //G feet
PROPOSED SYSTEM: Septic Tank (c-b gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench 7 G feet//Total System Length C?J feet
Seepage Pit(s) : Number of / Size each: ft. x ft.
Size of Stone to be used: # 2., / Depth or Thickness /lt 4 feet
**************
HOLDING TANK SYSTEM IF REQUIREp
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.
-�..� DATE: � 2 2 tr - y
SIGNATURE OF RESPONSIBLE PERSON: d
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:
111/1 //e:i/JA
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
A � ;� \k _ 1 --) fps
Name / 4(1, / l Fez-=-`/1eG'k
Location = ` a ;7'
Date / .9-f` <,l Permit #
SOIL TYPE: •" i +
Results of Percoi .ti 'n est-
(if applicable) R.t,-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: otal ;Length `mac
Length of each e ch c.{-•
Depth of trenc -s
Size of stone
SEEPAGE PIT N um i e r-
Size - ft. x —
Stone si - _ -
PIPING• -M Size Type
Bid. to Tank nCtS
T. to Dist. Box Z'r,
Dist. Box to Field/pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank
Foundation to Absorption feet
Separation of Pits � eet
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPERTY:
( _le one)
Front - Rear - . -ft Side - Right Side
i . . e Front - Mid. e 'ear
IOMMENTS:
W T7 �
SYSTEM USE APPROVED: YE NO
Arrived:
Departed: (I 30
Building In pe o
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i . ,- :;:-:,'3r1 oi observed,or believe I saw epdence of, DEC 1p,,ft.4.
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Thuses, wells, trees, fences 0, etc., -
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liTs docuii,ent. I aiso represent that I have
rtally measured the 'stances t forth on the diagram."
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