92-485 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date August 12 19 92
This is to certify that work requested to be done as shown by Permit No. 92-485
has been completed.
This structure may be used as a septic system
Location Glen Lake Road
Owner Robert Potter
By Order of Town Board .
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY o
No. #92-485
WARREN COUNTY, NEW YORK
I
N
PERMISSION is hereby granted to Robert Potter
OWNER of property located at Glen Lake Road Street,Road or Ave.
in the Town of Queensbury,To Construct or place a Septic Alteration 0
at the above location in accordance to application together with plot plans and other information hereto filed and e'I'
e+
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
Patten Mills Rd c
Ft Ann, NY
2. CONTRACTOR or BUILDER'S Name
Queensbury Sewer
fD
3. CONTRACTOR or BUILDER'S Address f
7C'
fD
O.
4. ARCHITECT'S Name
Vf
fD
.
5. ARCHITECT'S Address
e+
fo
6. TYPE of Construction—(Please indicate by X) —'•
O
( 1 Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
Septic Alteration to include:
No. 1 seepage pit 10' x 8' using #3 stone, 2' thickness as per plot plan s.rf
specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID—THIS PERMIT EXPIRES August 10, 1994
(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 Day f Au ust 19 92
SIGNED BY 22 for the Town of Queensbury
Building and Zoning In ctor
ei0k
Ai
TOWN OF 8 1;7" 0.�_
APPLICATION FOR SEPTIC iSPERMIT Permit #
'�' Fee Paid,,
AN 1992
02
a-1.61 Received
Date: 7- �_ Awn o1Queensbell a Reviewed By
LOCATION OF PROPS Y FOR INSTALLATION: - x <o 1'0t(
Owner' s Name: Ce
Owner' s Mailing Address �t. { { ( ( p,
f 7//r*
Installer' s Name: ?e, s. /E; u ,- ' �;.J — Phone #: 77 023 $Y
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom): /S
Topography-Circle One: 000 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:jiTot RequiFe ,Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal �WelT)Other
If domestic water supply is a well -
Separation: Water supply from a�t septic absorption /S ZJ feet
e•ST.
PROPOSED SYSTEM: Septic Tank /c-0-6 gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet c)
Seepage Pit(s): Number of 1 / Size each: / ft. x ft.
Size of Stone to be used: # f3 / Depth or Thickness 2_ 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: T2 DATE: /.,(, � Z _
v~7
4
°7
t s.X
SAtic stem 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:
Jown o/ Queenitur, ,BUILDING and ZONING DEPARTMENT . /xi
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME1�f /Zl .��,
LOCATION, 0_,,dev
DATE / q..z PERMIT NO. g?
SOIL TYPE 41105 Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total le th
Length of each trench
Depth of tre hes
Size of gravel_ 11 _
SEEPAGE PITS{N r of)
Size- if ft. X ft. -/- A'
Gravel size # 3
PIPING: ize Type
Bldg. to tank 1•Pl
Tank to dist. box -----
Dist. box to field/ ' y- 23P2- SS
Openings sealed? YE NO Partial
LOCATION/SEPARATIONS:
Foundation to tank _raSi-ft.
Foundation to absorption SO ft.
Absorption to lot line /0 ft.
Separation of pits ft.
LOCATION_ SYSTEM ON PROPERTY(circle one)
Front earr - Left side - Right side -
COMMENTS:
[fie ate_
\64,• 4‘447-
SYSTEM USE APPROVED
Bui ding Inspector
01/86 and vl
... ,
.
,
r'•-•:.--1 a-iiiii!
151)1
4 -ip
ov A0.
1 A118 199?
CP
..a,
n R • *4
eV
17, ow
i neofcaelved
d, uldg D
• ePt, '
4444 40, tta'''
Itil I
i
1 - -
4 4
--- ...
_....,
I --'"--44 —e. '‘-'t 4
1 •1 _a
, 1
i —
,•„„,0 I ,
•„„e)
.,
•1,.6 j.....„
Nst\
4t. 4: 0'd• )
J
I,
1
i
1
\ 1
.-.
,
,
1
1
__
.....___.> •___.
-----...„
/
--,.•..., I
/ ........ 1
/ •...,
.--..1
//
1