91-770 9
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CERTIFICATE OF COMPLIANCE
TOWN'OF OUEENSBURY
WARREN COUNTY, NEW YORK
Date 19
This is to certify that work requested to be done as shown by Permit No. 91®770
has been completed.
This structure may be occupied as a Septic Alteration
Location 4 New Pine Street
Owner Bernard Legaul t
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-770 �
WARREN COUNTY, NEW YORK a
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PERMISSION is hereby granted to Bernard Legaul t
OWNER of property located at 4 New Pine Street ~'
Street, Road or Ave.
Alteration a
in the Town of Queensbury,To Construct or place a Sewage
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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.
1. OWNER'S Address is
Same
2. CONTRACTOR or BUI LDER'S NameIT
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Sanitary Sewer
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction— (Please indicate by X)
( )Wood Frame ( ) Masonry ( ) Steel ( ) M
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7. PLANS and Specifications
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No. Septic alteration to include: 1000 gal . Tank as per plot
plan specifications and application
8. Proposed Use
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Septic Alteration !+
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 31, 19 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 thi 31St Day of October 19 91
SIGNED BY / ' p' ;/ for the Town of Queensbury
Building and Zoning Inspector
1 1V ew SD,2=3r ® O
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T OIAM OF UEEuyJIS B URY
REVIEWED B
DATE G�
TOWN OF QUEENSBURY '
APPLICA TIOH FOR SEPTIC DISPOSAL PERMIT
DATE: C) - TOWN OF QUEENSBUB-
�; RECEiVEn
LOCATION OF PROPERTY FOR INSTALLATION
Owner' s Name: TL�e_(L_Aj�1L7 Z-�
' �" ®C• �Address: L( /U2 C r %tie J'� CODE DEFT.
Installer' s Name: S1_117,�,y f'��,1., Telephone: lcd - >
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: Circle one: Fla Rolling Steep Slope % of Slope
Soil Nature: Circle one: and Loam Clay Other /Depth:
Ground Water: At what depth? - Feet
Bedrock or Impervious Material : At what depth? Feet
Percolation test: Circle one: <2�require required
Rate - Min. Per Inch
Domestic water supply: Circle one: unicipal Well Other
If domestic water supply is a. we
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank QV0 gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench , feet/Total system length feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used #. /Depth or Thickness feet
V HOLDING TANK SYSTEM IF REQUIRED
��- NO. of Tanks Size of Each Gal .
*Alara systm and associated electrical work to be inspected by an approved
agency.
I have read the regulation on the reverse side of this sheet and agree to abide
by these and all requirements he Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:`. -DATE:
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S+ptiC System 'Inspections': ,
A. All applications for septic system inacallacion alteration or"' repair,
as required by the Town of Queensbury Sanitary Swage Ordinance& shall
be submitted to the Building Deparcmenc at lease 24 hours`before scarc
of construction and shall include a plot plan showing:
1.) Cho proposed location of Cho system
2.) location and distance to lot lines
3.) location and distance to structures
4.) location and discince to any water supply
5.) size and dimensions of all canks, discribucion�boxes.
c1le -fields andLar_drywallsB. No system shall be covered before inspection and approval by the
duild ins Inspuctor. Failure to comply with this requirement may
rwsulc in the uncovering of cha system by Cho installer and a fins
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 ac cite of inspection may -
rasulc in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installs-
cion, alcaracion or repair of an approved system, a new proposal must
bQ submitted to the Qug.:nsbury Building--Deparcmcnt before further
conscruction.
Town of Queensbury
BUILDING and CODES DEPARIM NT
Bay and Naviland Roads
Queensbury, New York 12804
1
Down of QueenjLry ' '30
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME 3 �
LOCATION
DATE / PERMIT NO. 9
SOIL TYPE Sand Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM: rr
Absorption field, total;`length,/
Length of each trench % 4�
Depth of trenches
Size of gravel"_ _
SEEPAGE PITS{Number of),,'
Size- ft. X
Gravel size
PIPING: (`,Size Type
Bldg. to tank
Tank to
Dist. box to field/,' 't
Openings sealed? ' ,,ES- NO Partial
LOCATION/SEPARATION�S
Foundation to tank r) AD ft.
Foundation to abs o ,ption ft
Absorption to lot line ft �
Separation of�`pits' ft. L�
LION OF SYSTEMION PROPERT (circle one)
o - Rear - Left side - Right side COMMENTS:
SYSTEM i
l
SYSTEM USE APPROVED YE N
Bui d'ng Inspector
01/86 and vl