91-853 t
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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date DECEMBER 27, 19 91
This is to certify that work requested to be done as shown by Permit No. 91-853
has been completed.
This structure may be occupied as a Septic Alteration
Location_ 7 Midnight Drive
Owner Donald Cartier
By Order Town Board
TOWN OF QUEENSBURY
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Director of Bldg. & Code Enforcement
BUILDING PERMIT
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TOWN OF QUEENSBURY
No. 91-853
WARREN COUNTY, NEW YORK c
PERMISSION is hereby granted to Donald Cartier
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OWNER of property located at 7 Midnight Drive Street, Road or Ave.
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
Same
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2. CONTRACTOR or BUI LDER'S Name
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Condon's Septic & Drain Service 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 `rt
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6. TYPE of Construction— (Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
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7. PLANS and Specifications
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No.Septic Alteration to include: 2 seepage pits each 8' x 8' using 13
stone, 2' thickness as per plot plan specifications and application
8. Proposed Use
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Septic Alteration
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$ 95 00 PERMIT FEE PAID —THIS PERMIT EXPIRES December 12. 19 9.3_
(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 this 12th Day of ember 19 91
SIGNED BY �ta� for the Town of Queensbury
Building and Zoning VVpector
TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPO,SA,L �P)ERMIT�ENei-� Permit #
'L.Hi ED Fee Paid
Date: Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION:
Owner' s Name: TQ//,,1.D C
Owner' s Mailing Address: 17 R G-1 ;g1,
Installer' s Name: CXW06,lyS �\ 0-Lc �ol,r79f�vs�i� Phone #ff
:
Number of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 gal . per bedroom): 5 C3
Topography-Circle One: Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth:
Ground Water-At What Depth? , y��f Feet
Bedrock or Impervious Material-At What Depth? A)4 Feet
Percolation Test-Circle One: o�Requirel 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
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PROPOSED SYSTEM: Septic Tank / gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s) : Number of 21 / Size each: 8� ft. x ft.
Size of Stone to be used: # J�? / Depth or Thickness 2— 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.
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SIGNATURE OF RESPONSIBLE PERSON: _ DATE:
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 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 V Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks:
—Tku (- S `
Jown o f Queenj6ury , of
BUILDING and ZONING DEPARTMENT .
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAMEc�
LOCATION
DATE
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total_ -len
Length of each trench /
J t.a....1.--
Depth of trenches �P;�
Size of--gravel _
SEEPAGE PITS{Number of L--
Size- — '5(ft. X -ft
Gravel size - a cd -V
PIPING: 812e Type
Bldg. to tank (5T I i"t'
Tank to dist. box 17V C-
Dist. box to field/pit t¢_
Openings sealed? YE NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft
Foundation to absorptio ft. 01(
.Absorption to lot line f
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - R. ar - Left side— Right side COMMENTS:
SYSTEM�'XiJS'-rr �L--•I�1,�-AIL. �-tip�z.���c��
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SYSTEM USE APPROVED Y S NO r
Building Inspector
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clews �ra�js
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