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CERTIFICATE OF COMPLIANCE '
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date /4e1'dfX114/i 19
This is to certify that work requested to be done as shown by Permit No. 91-578
has been completed.
This structure may be occupied as a Septic Altesation
Location Clevercialp Rd
Owner John Labarge
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBURY No. 91-578
WARREN COUNTY, NEW YORK t. z
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PERMISSION is hereby granted to John Labarge 1 w
OWNER of property located at Cleverdale Road Street, Road or Ave. o
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.
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1. OWNER'S Address is
tp
Same fD
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2. CONTRACTOR or BUILDER'S Name
Condon's Septic Service ID
3. CONTRACTOR or BUILDER'S Address a.
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4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) 011
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1 )Wood Frame ( ) Masonry ( )Steel ( )
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7. PLANS and Specifications 0
No. Septic Alteration to include: 2 Tanks each 2000 Gal . as per plot
plan specifications
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES August 16 1993
(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 h Day of . August 19 91
SIGNED BY ��>%;.r for the Town of Queensbury
Building and Zoninglrspector
#at:
� j TOWN OF QUEENSBURY 9 ��t
APPLICATION FOR SEPTIC D A PERMIT Permit # - t
Fee Paid � CZ%
Date: g— 1 y - j Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: Oi_ ,V ,( D1le /GI
Owner' s Name: 7:S ph y) J a A ' 6 E �6,j
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Owner' s Mailing Address: CJc y/ YkDAli it4. C icy ri A-le it'
Installer' s Name: &f �7 C Phone #: 7 't — ;57 c--'
( ,jdoyijc
Number of bedrooms (if residential ) : 3
Total daily flow (residential-compute @ 150 gal . per bedroom) :
Topography-Circle One: Flat 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? '.'"T :,Fee . E.::.'',:.
Percolation Test-Circle One: Not Required Required/Rate Ir er Itch
Domestic Water Supply-Circle One: Municipal Well Other T AG 3�91 `;,'
If domestic water supply is a well -
Separation: Water supply from any septic absorption I�faet.OLe 1.,c.P .
PROPOSED SYSTEM: Septic Tank 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 a Size of Each O O 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: 2647 _ DATE: t 7 -_9(
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:
Jouin of Queensbury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME t r
LOCATION L. :vL r ,/
DATE / (� / `(I PERMIT NO. 9� ✓//'7
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 pf)
Size- ft. X /ft.
Gravel size
PIPING: ' Siz: Type
Bldg. to tank
Tank to dist. box
Dist. box to field pit
Openings sealed? YE- NO Partial
LOCATION/SEPARATIOV-:
Foundation to tankt, ft.
Foundation to abs•' ption ft.
Absorption to toLine ft.
Separation of p''ts ft.
LOCATION OF SY0tE4 ON PROPERTY(circle one)
Front - Rear / Left side - Right side -
COMMENTS: -
k✓_4 I ,4 At-cc 6/ ( r D k jci
r/%.; C-,
4 r
;L = Fu 4L f L SYSTEM USE APPROVED YES NO-
1
Bildin I spector
01/86 and vl
. own of Queeniturj
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
• Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTIONI_
NAME c .(i�bax �OV 1 Y1
LOCAT I ON Lrl U'1'1.g
eke );NAGS6y\
le—
DATE / PERMIT NO. N,c;
� _ �
SOIL E- Sand - Loa �2 y -
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 PITS4Number of)
Size- ft. X _ ft.
Gravel 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 ft.
Foundation to absorption ft.
Absorption to lot line ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS:
SYSTEM USE APPROVED YES NO
Building Inspector
01/86 and vl
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awn o/ Queen Jur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
- l C,"\ e - I_() 1L I l.'�-)r�_ .3
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME . 4- r), 77.._C, =L
LOCATION tRc F. v�
DATE 1 Z 5/ II PERMIT NO.
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 PITS4Number of)
Size- ft. X ft. A
Gravel size
i'
PIPING: st Sizes Type /
Bldg. to tank 2 'act} 4401°C
Tank to dist. box
Dist. box to field/pit
Openings sealed? YES ',NO artial
LOCATION/SEPARATIONS:
Foundation to tank T t.
Foundation to absorption : ft.,
Absorption to lot line ft.
Separation of pits r ft.
LOCATION OF SYSTEM ON OPERTY(circle one)
Front - Rear - Left s'de - Right side -
COMMENTS:
c -;
J I 1
St<�� ►z3r` /��ouM.( Ci-�.CUL W U4LtJI—
SYSTEM USE APPROVED YES NO
B ildingi I pe or
01/86 and vl