93-281 •
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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date (2., 4,Zii 4/ 19 l3
This is to certify that work requested to be done as shown by Permit No.93-281
has been completed.
This structure may be used as a septic system
Location Seelye Road
Owner Jospeh Roulier
16-1-65 By Order of Town Board .
TOWN OF QUEENSBURY
CaLA
Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 93-281 ro
WARREN COUNTY, NEW YORK z
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PERMISSION is hereby granted to JOSEPH ROULIER H,
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OWNER of property located at See lye Road Street,Road or Ave.
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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.
1. OWNER'S Address is ::1
PO BOx 301
Cleverdale NY 12820-0301
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2. CONTRACTOR or BUILDER'S Name
self Q
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3. CONTRACTOR or BUILDER'S Address 1-0
4. ARCHITECT'S Name
5. ARCHITECT'S Address O
n
fi
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6. TYPE of Construction—(Please indicate by X) rt
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
Septic alteration to include 1000 gallon septic tank and
No. 240 feet of tile field at 60 foot lengths as per plot
plan and application.
8. Proposed Use
U]
Septic system
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25 . 00 JUNE 9 95
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19 H
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the (t
(I)town of Queensbury before the expiration date.)
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Dated at the Town of Queensbury this 9 th Day of June 19 .93 rt
SIGNED BY for the Town of Queensbury
Building and Zoning ctor
41,1
TOWN OF QUE V3970777 (°
APPLICATION FOR SEPTIC DI SAL PE�+1IT � Permit #
c Fee Paid A
JU(N 1993
M Receiv
Date: �/ 9_3 �, Tor 8m v eviewed By
LOCATION OF PROPERTY FOR INSTALLATION: . 1,Z j °/,
z �
Owner's Name: o tips ZEZ ev."Z e;
Owner' s Mailing Address: hie _30// /oGOZo
Installer' s Name: �,_,;s �� -q ' ' �� Phone #:
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom) : yfa .
Topography-Circle One: Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand 603) Clay Other /Depth:
Ground Water-At What Depth? / f Feet
Bedrock or Impervious Material-At What Depth? N Feet
Percolation Test-Circle On: : Not Required 'equired/Rate Min. Per Inch ? ,i/°
Domestic Water Supply-Circle One: Municipald11100 Other _
If domestic water supply is a well -
Separation: Water supply from any septic absorption /06 'Y— feet
PROPOSED SYSTEM: Septic Tank /oo o 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
by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: .— DATE: 4/l —
1 �f+P{1'1:1S
Septc,•-$ystem Inspections:
rytto,mA. All application ,;}.for sgptIt system installation, alteration or repair,
as required by the;_, Town of Queensbury Sanitary Sewage Ordinance, shall
be submitted to the;:;;Buil di.ngDepartment at least 24 hours before start
of construction and shi Th1=-=i-ncllude 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:
/507&;g4
TOME OF QUEENSBURY
BUILDING E CODE EMFORCEMENT/`
531 Bay Road
•
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM IPNSPECTION
Name (5
Locatio
Date Pe it #
SOIL I PE: Sant-Load- lay- -
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTIOVN FIELD: Total Length 2-Q
Length of each trench 6-,e,
Depth of trenches �- Y
Size of stone ;,
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size )
PIPING: Size' Type
Bldg. to Tank i Li / EX;s
Tank to Dist. Box 14 /' -- '
Dist. Box to Field/P' ' S
Openings Sealed? up / No Partial
LOCATION/SEPAL':I TIONS:
Foundation to Tank / LO feet
Foundation to Absorp o, 3., feet
Separation of Pits c feet
Conforms as per Pl o P1 a , Yes No
LOCATION OF SYSTE Om PRO ERTY:
(circle one)
ron - Rear eft Side Tht Side
fiddle Front - fiddle Rear
COMMENTS:
1 if L,„,
SYSTEM USE APPROVED: C NO
Arrived: / .'
Departed: ?gyp 4 if
Building diiOs ector