91-495 yl
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19 11
This is to certify that work requested to be done as shown by Permit No. 91-495
has been completed.
This structure may be occupied as a Septic Alteration
Location
1613 Moon Hill Rd
Owner Harold Rathbun
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
10
BUILDING PERMIT a
TOWN OF QUEENSBURY
No. 91-495
WARREN COUNTY, NEW YORK w
PERMISSION is hereby granted to HarOld Rathbun
OWNER of property located at 1613 Moon Hill Rd Street,Road or Ave.
in the Town of Queensbury,To Construct or place a Septic Alteration C
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. x
1. OWNER'S Address is
Same
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2. CONTRACTOR or BUILDER'S Name
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Condon's Septic & Drain Service
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3. CONTRACTOR or BUILDER'S Address
and
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address t7
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6. TYPE of Construction—(Please indicate by X)
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( 1 Wood Frame ( ) Masonry ( I Steel ( )
7. PLANS and Specifications
No. Septic Alteration to include: 1000 gal Tank, replacing old metal
Tank
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES July 10, 19 93
(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 10th Day of July 19 91
`
SIGNED BY \/ 4'' for the Town of Queensbury
Building and Zoning Spector
s
02PY TOWN OF QUEENSBURY C� 1_
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # S
Fee Paid ;15< c-
-or gip ot: F.;�l EEN::f ,,.
Date: q ` 1 7 Revi- r r W elp4 , , a
LOCATION OF PROPERTY FOR INSTALLATION: / ( 3 1) t}0 Al 14 i! 0,
Owner' s Name: //4/ L7) %/ e? u A./ JUL 101991
Owner' s Mailing Address: / l_ . r r,� cr? 1/ 1 11 1/ / BUILDING & CODE DEPT.
Installer' s Name: (, ; *Ds'< ,• S , ; f, c.- - t�)I
� /I! ,5E, ; Phone #: / 7' _ ��Z-
Number of bedrooms (if residential : ----
Total daily flow (residential-compute @ 150 gal . per bedroom): VC CT
Topography-Circle One: Flat 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? 4) Feet
Percolation Test-Circle One: of Require ' Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal ell , Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption /A
fs feet
ly :. A /3-c-t 0 .D fhETea7 71 AwUc
PROPOSED SYSTEM: Septic Tank /OCC 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
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
TO desanvi d llitt ts "uy f the Town of Queensbury Sanitary Sewage Disposal
:I~IGNA TiIRE' 9R 'ii 4 P .P� '� ( � `-a,
�" —e"'Y'4—C'"°w'� DATE: 7 ^? _ ?(
REVIEV, ::L; u
DATE i
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:
(::1-1(4)
gown o19 Queennury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION /( 7/ 72 7vx %46,/ ,/
DATE 7f2,.%/ '7/ PERMIT NO. q/`-
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) ;`
Size- ft. X ft. a
Gravel size
PIPING: Size Type
Bldg. to tank A `ter r '-U k ti -
Tank to dist. box I
Dist. box to field/pi
Openings sealed? YES NO Partial
,
LOCATION/SEPARATION: _
Foundation to tank/ ,/ ( f t f <.
Foundation to abs brption ft.
Absorption to lob' line ft.
Separation of pigs ft.
LOCATION OF SYSEM ON PROPERTY(circle one)
Front - Rear - eft side - Right side -
COMMENTS: f
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SYSTEM USE APPROVED YE NO /
Bui ding In ector
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VA "I BUILDING & CODE DEPT.
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