92-208 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19 92
This is to certify that work requested to be done as shown by Permit No. 92�208
has been completed.
This structure may be occupied as a
s.
Location 27 Rnul nva rd
Owner Steven A. Perry Jr 4.1
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
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BUILDING PERMIT T.
TOWN OF QUEENSBURY No. 92-208 v� N
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Steven A Perry JR
OWNER of property located at 27 Boulevard Street, Road or Ave. z
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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. evl
1. OWNER'S Address is rD
Same C.
2. CONTRACTOR or BUILDER'S Name
Ivan Bell
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3. CONTRACTOR or BUILDER'S Address G
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4. ARCHITECT'S Name G
5. ARCHITECT'S Address V
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6. TYPE of Construction— (Please indicate by X)
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( )Wood Frame ( ) Masonry ( ) Steel ( ) Gam+
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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
s 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 5' 119 cam_
(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 Queensbury7, .
Day f n 199_
SIGNED BY for the Town of Queensbury
BZoni Inspector
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TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
Fee Paid
Date: Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: .2 VJ
Owner' s Name: rv� �,I� T-�S� Q,�i1234�e
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Owner' s Mailing Address: �
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Installer' s Name: %y-c.11 Phone #: R —a�992
Number of bedrooms (i f residential ) : �j' `s'► �e� 'R'
Total daily flow (residential-compute @ 150 gal . per bedroom) : 6/0r0 �,L��
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Topography-Circle One: Fla Rolling Steep Slope % of Slope
Soil Nature-Circle One: San Loam Clay Other /Depth: '
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? _20) Feet
Percolation Test-Circle One: of Requir Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: unicipa Well Other
If domestic water supply is a we -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank gal . (Minimum size: 1,000 gal ..)
Tile Field: Each Trench ,f0 feet//Total System Length .2 vb feet
Seepage Pit(s): Number of Size each: ft. x ft.
Size of Stone to be used: # / Depth or Thickness i 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: i`�"`' ✓� DATE: �C—
Septic System Inspections:
A. ill applications for septic system installation, alteration or repair,
as- : .required by the Town of Queensbury Sanitary Sewage Ordinance, shall
esu,bNmitted to the Building Department at least 24 hours before start
of con,,struc.tion and shall include a plot plan showing:
1)..,,the p'ropos:ed .location of the system
2):'- 1 ocati'dn and di stanC'e to 1 ot. 1 i nes
;cation and 'distance to structures
l :caton and distance to any water supply
' size ,;and dimensions of all tanks, distribution boxes, tile fields
a n y o'r d rywe l l s j.
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 _.qfl.the system by the installer and a fine of up to $250.00.
C. An approved dopy 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:
Jown o f Q u njLry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION J
DATE 1:5 /k PERMIT NO. �2 --=?O Op
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation ate - Min/Inch _
TYPE of SYSTEM:
Absorption field, total length �OiJ
Length of each trench So
Depth of trenches ' Z
Size of gravel_'; -Z_
SEEPAGE P ITS4Nuinber{?of)
Size- ft. X _�� ,E` ft.
Gravel size f
PIPING: Size . Type
Bldg. to tank _ w C_
Tank to dist. box ; Qv'L—
Dist, box to field/pi pu C._
Openings sealed? ES !, NO Partial
LOCATION/SEPARATIONS:
Foundation to tankft.�
Foundation to absorption 20
Absorption to loft line
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front Left side fight si -
COMMENTS:
SYSTEM USE APPROVED ES NO
Building Ins ector
01/86 and V1
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