92-786 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date /P.P.imc . //a 19 9..2
This is to certify that work requested to be done as shown by Permit No. 92-786
has been completed.
This structure may be used as a septic system
Location Tee Hill Road
Owner Steven Britton
48-3-50.2 By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
—I
x
BUILDING PERMIT
TOWN OF QUEENSBURY •
No. 92-786
WARREN COUNTY, NEW YORK -P.
o
PERMISSION is hereby granted to STEVE BRITTON o
OWNER of property located at Tee Hill 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.
1. OWNER'S Address is co
7a
same ►y
2. CONTRACTOR or BUILDER'S Name
Queensbury Sewer
m
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
---I
CD
5. ARCHITECT'S Address CD
J.
.J
70
6. TYPE of Construction—(Please indicate by X1
C.
1 1 Wood Frame ( 1 Masonry ( )Steel ( )
7. PLANS and Specifications
No. Septic alteration to include replacement of 1000 gallon tank only
as per application and plot plan.
8. Proposed Use
Septic system
n
lc
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES December 15 19 94
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the c+
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury thi h ay December 19 92
SIGNED BY for the Town of Queensbury
Bui ding and Zon Inspe or
;4 4 TOWN OF Q1 ENSBURY
1.APPLICATION FOR SEPTIC DISPOSAL PERMIT Omit # �?-7f
,, d F OUE. ' �'F�aid
RECEIVE
S
, )1'
Date: Cas4, ( - ci L EC IRMINed By
LOCATION OF PROPERTY FOR INSTALLATION: 1 /' 'coDE/ Ep7).
Owner's Name: � �,
Owner's Mailing Address: 7 e //, // jP Cr- it- i,
Installer's Name:
T # Phone #:
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal .
per bedroom): l4
Topography-Circle One: Fla Rolling Steep Slope % of Slope
Soil Nature-Circle One: San Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: of Reouiredtequired/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal We lI Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption /(C) feet
PROPOSED SYSTEM: Septic Tank A ) gal . (Minimum 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
OJ No. of Tanks Size\of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
(I) 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: r \_4,t DATE: 2
cc��
Jown of QueenJbur, `
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME s�.�'7±`.:2e , ; �
LOCAT ION //// ,X r-,r
DATE /0 / PERMIT NO. - /:e0
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches .
Size of gravel
SEEPAGE PITS{Number of) r
Size- ft. X ft. f'r
Gravel size
PIPING: Size ,Type
Bldg. to tank
Tank to dist. box {.
Dist. box to field/pit r
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank / ft.
Foundation to absorption;' ft.
Absorption to lot line;' ft.
Separation of pits ft.
LOCATION OF SYSTEM O PROPERTY(circle one)
Front - Rear - Leftjside Right side -
COMMENTS:
r"?r'l ,'t - c t( o
SYSTEM USE APPRO Y`EB) NO
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