93-730 , CERr'"IFIQ
TOWN OF QUEEMSBURY
WARREN COUNTY, NEW YORK
Date
19 9�
This is to certify that work requested to be done as shown by Permit No, 93-730
has been completed.
This structure may be used as a septic system
Location 32 Twin Mountain Drive
Owner- Clifford South
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By Order of Town Board
OWN 0 GrNSBURY
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Director of Building & Code -Enforcement
BUILDING PERMIT
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TOWN OF QUEENSBURY x
No. 93-730 t
WARREN COUNTY, NEW YORK
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CLIFFORD SOUTH
PERMISSION is hereby granted to O
32 Twin Mountain Drive
OWNER of property located at Street, Road or Ave.
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in the Town of Queensbury,To Construct or place a Septic Alteration w
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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. Ln
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1. OWN S,Address is ~
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2. CONTRACTOR or BUI LDER'S Name C�
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3. CONTRACTOR or BUILDER'S Address ~
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address N
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6. TYPE of Construction—(Please indicate by X) {
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( )Wood Frame ( ) Masonry ( )Steel ( )
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7. PLANS and Specifications
Septic alteration to include one 10 ' x8 ' Seepage Pit
N°' with #3 stone at 1 ft. as per plot plan and application.
8. Proposed Use
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A Septic System rt
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$ 25 . 00 PERMIT FEE PAID —THIS PERMIT EXPIRES December 3 1995
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(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.) (D
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Dated at the Town of Queensbury this n-r Day o De ember 19 93
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SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
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TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # R
Fee Paid
Date: /� _ - D Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: `i r k- —1
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Owner' s Name: , �' . r,� �'' vorI 4 I
Owner's Mailing Address: - �' "� �C14 ,,,°�� c� DEC 1993 0
f N Town�ofed
Installer's Name: Phb #: Q
Bldg pept �
Number of bedrooms (if residential ): c
Total daily flow (residential-compute @ 150 gal . per bedroom): 0 , 6L 86 IQ
Topography-Circle One: .5San
Rolling Steep Slope % of Slope
Soil Nature-Circle One: Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Feet
Bedrock or Impervious Material-At W epth? � // Feet
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal ell Other
If domestic water supply is a we -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank F ,) J gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s): Number of / Size each: --kft: x —Zft.
Size of Stone to be used: # - / Depth or Thickness feet
HOLDING TANK SYSTEM IF REQUIRE
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: L
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 old 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: ;
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------ ----�---- j
REV-* EY
DATE
I --
T0WN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name _ of
Location 3-2 nLfx_
Date ,2 Permit # 7
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Da-st:Bax`
Dist. Box to Field/Pit
Openings Sealed? Yes —No Partial
LOCATION/SEPARATIONS:
Foundation to Tankle � ,c�.,� eet
Foundation to n feet
Separation of Pits �' _ feet
Conforms as per P1 of P1 an Yes No
LOCATION OF SYSTEMION ROPERTY:
(circle one)
Front - Left Side - Right Side
Mi d� n Middle Ream,
SYSTEM USE APPROVED: YE .. NO
Arrived:
Departed:
Build7 spec or