92-044 rt
-
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 9uLy 1519 eig
This is to certify that work requested to be done as shown by Permit No. 92-044
has been completed.
This structure may be occupied as a Septic Alteration
Location Fielding Lane, Cleverdale, NY
Owner Gary P. MoorP
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. Code Enforcement
--I
BUILDING PERMIT
TOWN OF QUEENSBURY o
No. 92-044 •
WARREN COUNTY, NEW YORK N
PERMISSION is hereby granted to Gary P. Moore v,
OWNER of property located at Fielding Lane, Cleverdale, NY 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 0
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
rti
1. OWNER'S Address is C)
9 Moorwood Drive
Queensbury, NY 12804
2. CONTRACTOR or BUILDERS Name
ACI Builders
3. CONTRACTOR or BUILDER'S Address fp
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4. ARCHITECT'S Name a
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
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( 1 Wood Frame ( ) Masonry ( )Steel ( ) fD
7. PLANS and Specifications
Xt.
No. Septic Alteration to include: 2000 gal. Holding Tank as per plot plan
specifications and application Variance approved March 16, 1992 -
8. Proposed Use
O
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES March 27, 19 94
(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 Day March 19 92
SIGNED BY for the Town of Queensbury
Building and o Inspector
oz c35,92 10: 4E a
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� 1 TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # -O'i4-
Fee Paid
Date: illy__ Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: 66242416 (A J Ciiv42b4WJ
,A .y
Owner' s Name: 6ARy P. Moo
Owner' s Mailing Address: Q hiem j 7alU£ QOEan"� ort
Installer' s Name: A Phone #:
675(0-3loZA
Number of bedrooms (if residential ): 3
Total daily flow (residential-compute @ 150 gal . per bedroom): S'Q
Topography-Circle One: 4 Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other
/Depth: y.,s'
Ground Water-At What Depth? ± q.$.' Feet
Bedrock or Impervious Material-At What Depth? t4p Feet
Percolation Test-Circle One: (Not Required) Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other LAKE Svppni--p
If domestic water supply is a well -
Separation: Water supply from a� septic absorption feet
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 Size of Each 2000 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: DATE: 2/0 Z
Jotun of Queeniu,., 111
...
r BUILDING and ZONING DEPARTMENT
/ ' Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
4Au aattlioll --c-
SEPTIC DISPOSALL SYSTEM INSPECTION
NAME /16-@'C.ft--
LOCATION 44,siGMPub
DATE %X / 9-„ PERMIT NO. 0- j"/` `t V
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.
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box
Dist. box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARA 'IONS
Foundation to t k ft.
Foundation to ab oration ft.
Absorption to lot ine ft.
Separation of pit-.. ft.
LOCATION OF SYST 'N PROPERTY(circle one)
Front - Rear - Le t side - Right side -
COMMENTS:
122e rifte A, ,/ /66,4_ z___
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SYSTEM USE APPROV YES 1
Bun ding Inspector
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BUILDING and ZONING DE?ART
MENT
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Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION L.I'll
DATE 4E / 47-L PERMIT NO. - I
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES
Percolation rate - Min/Inch NO
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches
Size of gravel
SEEPAGE PITS{Nu er of)
Size- ft. X
Gravel size - ft.l,
PIPING:
ize 'T
Bldg. to tank �' YPe
Tank to dist. box
Dist. box to field/pi 0
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Openings sealed? YES
NO Partial
LOCATION/SEPARATIONS:
Foundation to tank s
Foundation to absorptioli ft.
ft.
Absorption to lot line.,-'l.
ft.
Separation of
pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left/side - Right side -
COMMENTS: f
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SYSTEM USE APPROVED YES NO
Building Inspector
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