93-510 CERTIFICATE. OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Da to �.ra 4.11A i J19 19
This is to certify,that work requested to be done as shown by, Permit No. 93-510
has been completed.
This structure may be used as a septic system
Location 224 Aviation Road
Owner P. Raymond Keyes Jr.
80-1-2 By Order of Town Board
MN OF QUEENSBURY
L
Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY ro
No, 93-510 z
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WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to P. RAYMOND KEYES JR. l o
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OWNER of property located at 224 Aviation Road Street, Road or Ave. N
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 trJ
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same
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2. CONTRACTOR or BUI LDER'S Name SL
Signorelli & Son Inc
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3. CONTRACTOR or BUILDER'S Address C-I
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4. ARCHITECT'S Name
N
5. ARCHITECT'S Address N
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6. TYPE of Construction— (Please indicate by X) Iv
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F'.
( )Wood Frame ( ) Masonry ( )Steel ( ) 9
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7. PLANS and Specifications
Septic alteration to include 140 feet of tile field at 47
No. ft lengths as per plot plan and application.
B. Proposed Use
Septic system
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$ 25 . 00 PERMIT FEE PAID —THIS PERMIT EXPIRES August 27 19 95 'rt
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the C]
town of Queensbury before the expiration date.)
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Dated at the Town of Queensbury this 2 7 th Day of August 19 93 r
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SIGNED BY Ct
U.C1 for the Town of Queensbury H_
�: angand Zoning Inspector 0
TOWN OF QUEEN
APPLICATION FOR SEPTIC DISPO. IT : i ,
� eqlFeerrmlmn
Date: tl®. Rev* `' By
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LOCATION OF PROPERTY FOR INSTALLATION: p/
Owner's Name: Ike�If � 0
�Ur�lia�
Owner' s Mailing Address: q
Installer's Name: jL_ oUD���� � � �Phone #: 11 3'�46 r
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom) :
Topography-Circle On lat Rolling Steep Slope q of Slope
Soil Nature-Circle One- Sand Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: N=Municipa
equired/Rate Min. Per Inch
Domestic. Water Supply-Circle OnWell Other
If domestic water supply' i
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank gal . (Minimum size: 1,000 gal . )
Tile Field: - Each Trench / feet//Total System Length feet
(s) : Number of / Size each: ft. x ft.
Size of Stone to be used: # / Depth or Thicknessfeet
**************
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: o 2 �3
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' Septibl' System Inspections:
A. All applications for:rseptic 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:
J
-10W OF SBIIRY
BUILDING & CODE ENFORCE&�ENT
531 Day Road
Queensbury My 12004
519-745-4447
u-6 SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location ��
Date 3 Permit # 1 -51 b
SOIL TYP San - oam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inchd�
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length jT7
Zf
Length of each trench +�
Depth of trenches 3
Size of stone
SEEPAGE PITS: Number-
Size -_ . x
St size
PIPING: Size Type
Bldg. to Tank Crj --
Tank to' Dist. Box _ VC
Dist. Box to Field/Pit
Openings Sealed? Yeas No Partial
LOCATION/SEPARATI -
Foundation to Tank 7 feet
Foundation to Absorption — feet
Separation of Pits feet
Conforms as per P1 of P1 an es No
LOCATIGH OF SYST1[N ON PRCPERTY:
(circle o '
Front Rear Left Side - Ri ht Side
Middle ron? - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YE No
Arrived: 3. S
Departed: : .5-0
Buildin Inspector
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