94-492 _______ ___
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 611313 19 9 y
This is to certify that work requested to be done as shown by Permit No. 94-497,_
has been completed.
This structure may be used as a septic system, replacement of pump chamber
Location Cleverdale Road
Owner Mr. and Mrs. Robert W. Sherry
By Order of Town Board
Tax Map No. 14-2-16 TOWN OF QUEENSBURY
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Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY 94-492 K b
No.
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Mr. and Mrs. Robert Sherry N
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OWNER of property located at Cleverdale Road Street,Road or Ave.
in the Town of Queensbury,To Construct or place a septic system
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
Mr. and Mrs. Robert W. Sherry
P.O. Box 193
Cleverdale, New York 12820
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2. CONTRACTOR or BUILDER'S Name a
Sonsoval, Inc. John Mason
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)
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( I Wood Frame ( ) Masonry ( I Steel (x) replacement of pump chamber (-)'
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7. PLANS and Specifications
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8. Proposed Use
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septic system 5
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES September 9 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 Day of ., September 19 94
SIGNED BY for the Town of Queensbury
Building and Zoni spector
/11-d-41X4 lam
AMMIL
j TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT 8e:rmrt # q .4
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Date: August 30, 1994 Revie �WWed
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LOCATION OF PROPERTY FOR INSTALLATION: Cleverdale Road, ,C.lev-'lot
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Owner's Name' Mr. and Mrs. Robert Sherry \`,
Owner's Mailing Address: Cleverdale, NY 12820
Installer's Name: Sunsoval, Inc. Phone #: 656-9956
Number of bedrooms (if residential ): 4
Total daily flow (residential-compute @ 150 gal . per bedroom): 600
Topography-Circle One: Flj Rolling Steep Slope % of Slope
Soil Nature-Circle One: S and; Loam Clay Other /Depth:
Ground Water-At What Depth? over 4 Feet
Bedrock or Impervious Material-At What Depth? over 4 Feet
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other Lake
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
(existing) replacement of -purn,Q
PROPOSED SYSTEM: Septic Tank 1000 gal . (Minimum size: 1,000 gal . ) c ambe►-
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s) : Number of / Size each: ft.�yac� : cf U "
Size of Stone to be used: # / Depth or Thickness . =, fee t
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trorif=7/1,********** r*** ' ,HOLDING TANK SYSTEM IF REQUIR
No. of Tanks
Alarm system and associated electrical work to be inspected by a .-rtified
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: J-
DATE: 8/30/94
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:
p- m
TO OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name A O ,r ...6)4.401."(
Location C. Q.Udcth li4
Da ,'e 4 Jalo/q4 Permit # gli -W 9d
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Tes"t-
(if appl 'cable) Rate-Minu /Inch
TYPE OF STEM:
ABSORPTIs FIELD: Total L-ngth
Length of e.ch trench
Depth of tre ches
Size of stone
SEEPAGE PITS: Number-
Size - t. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/'it
Openings Sealed? Yes No Partial
LOCATION/SEPARATI S:
Foundation to Tan feet
Foundation to Ab-orption feet
Separation of Pi s — — feet
Conforms as per Plot Plan Yes No
LOCATION OF SY EN ON PROPERTY:\
(circle one)
Front - Rear Left Side - Right aide
Middle Front Middle Rear
COMMENTS:
4� � liC- te'LR fj5"
SYSTEM USE APPROVED: YES NO
Arrived:
Departed: �`
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