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CERTIFICATE OF COMPLIANCE
, .
. TOWN OF gUEENSBURY
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; . WARREN' COUNTY; NEW YORK
: .
Date
,9f47...e /7 19 9.2.-
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This is tO—certify that work requested to be done as shown by Permit No. 92-349
has been completed.
This structure maybe usedas a
i . Septic Alteration .
. . Location : Mason Rd, Cleverdale. .
Owner ' John Bullard .
,
• . , By Order of Town Board . .
T QUEENSBURY •
, .
. ,
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, .. V .
•
. . Director of Building & Code Enforcement
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BUILDING PERMIT
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TOWN OF QUEENSBURY 0
2
No. 92-349
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to John Bullard ry
exi
OWNER of property located at Mason Rd, Cleverdale Street, Road.drAve.
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.
0.
1. OWNER'S Address is hi
Same v
2. CONTRACTOR or BUILDER'S Name
Queensbury Sewer a
IA
0
3. CONTRACTOR or BUILDER'S Address
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fD
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
4;
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
Septic Alteration to include:
No. 1000 Gal . Tank with 200' of Tile Field using #2 stone, 1' thickness
as per plot plan specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 17, 1s 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 17th Day of June 19 92
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
„,k,u.b., S
j TOWN OF QUEENSBitt' ' D/QUEENSBUe 1.
APPLICATION FOR SEPTIC DISPOSA I • • ECEWVED Permit # 902-,5 C1
Fee Paid /a.5—
/ JUN 16 1992
/Date: -- 1, G Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: 'YY01.60.81)P01 L)5. ��
Owner' s Name: `-SO 110 cc 11 d -Bui I arch
Owner' s Mailing Address: Vm,m n ct) ��� /�v�-✓�'-�I '�'�
Installer' s Name: itp0_6- 4z--1, a - Phone #:
Number of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 gal . per bedroom): 4/0-6
Topography-Circle One: Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sated Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At-What Depth? Feet
Percolation Test-Circle One:ot Require Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other Like Ce,rirrq.„
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank /ate gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench , t,-.0 feet//Total System Length feet
Seepage Pit(s) : Number of / Size each: ft. x ft.
Size of Stone to be used: # 2 / 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
by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance. / q
SIGNATURE OF RESPONSIBLE PERSON: lAx DATE:
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:
•
own o� Queen96ury
. BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME (`n
) ) � �C )
LOCATION 1 r:L S (Ca
DATE l p / 17 PERMIT NO. ! ) -3'/Q
SOIL TYPE - Sand Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM: •
Absorption field, total length /So.
Length of each trench ' _5'dp
Depth of trenches `
Size of gravel c�
SEEPAGE PITS*Number of)
Size- _ _ft. X _ --ft. ]i
Gravel size 1 /
PIPING: Size /Type
Bldg. to tank / Y / piA -
Tank to dist. box I V .( i/
Dist. box to field/pit „q di
Openings sealed? YES / NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to abso pti „2p ft.
Absorption to to line /o ft.
Separation of pi/ts /ft.
LOCATION OF SAY TEM ON P OPERTY(circle one)
Front -(Rear J)Left sid - Right side -
COMMENTS:
� IJ
SYSTEM USE APPROVE YES i
•
•
Bull I'ng Inspector •
01/86 and vl
Jown of Queeniturey
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
•
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME ,'�'��L�
LOCATION ///.1; • l/�.�
DATE o/i PERMIT NO. fW—S419
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- f,.t. 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/SEPARATIO S,:
Foundation to tan `; 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:
(//)
,-------4 ' '
esV,c___ 4S(Ci..
4-7/( \i/7 (5:: 11-
SYSTEM USE APPROVED YES NO
Building Ins ctor
•
01/86 and vl
`COWN OF QUEENSBUh
RECEIVED
JUN 1 1992
BLDG. & CODE DEPT.
CA.
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o 01
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I tEw
TOWM OF QUEENSBVRY
BUILDING C DEPT.! '
REVIEWED BY
DATE 6