91-857 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. 91-857
has been completed.
This structure may be occupied as a Septic Alteration
Location nooppnshurX Spupr
Owner NoTuan Nelson
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT w
TOWN OF QUEENSBURY
No. 91-857 %F*a
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Norman Nelson
OWNER of property located at County Cnlnny Drive Street, Road or Ave.
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in the Town of Queensbury,To Construct or place a Septic Alteration H
at the above location in accordance to application together with plot plans and other information hereto filed and o
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approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OWNER'S Address is
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2. CONTRACTOR or BUI LDER'S Name
Queensbury Sewer
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3. CONTRACTOR or BUILDER'S Address �C
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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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
No. Septic alteration to include: 2 seepage pits each 8' x 8' using o
03 stone, 2' Thickness as per plot plan specifications and application
8. Proposed Use
Sewage alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES December 13, 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 Recpmher 19 91
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SIGNED BY I for the Town of Queensbury
Buildingand Zoning Inspector
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TOWN'OF QUEENSB,4R X
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APPLICATION FOR `S�EPTIC,DISPOSAh`��P�R�rTy Permit #
"Fee Paid
Date: Reviewed14
LOCATION OF PROPERTY FOR INSTALLATION:
Ow., er' s Name: �� 3-V M
Owner'-s�Mail/ting Add,,Fes's': (. % If
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Installer' s Name: LC Phone #: G ^�J�� d
Number of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 gal . per bedroom): �d
Topography-Circle One: . Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One: S n Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: o Require Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other
If domestic water supply is a well -
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
-Seepage Pit(s) : Number of / Size each: . . ft. x , ft.
Size of Stone to be used: # / Depth or Thickness feet
HOLDING TANK SYSTEM IF REQUIREp
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: f 2
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 & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks:
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BUILDING & Cas a Db Rs',
own of Queenjburly
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME i�i�
LOCATION
DATE �.' �v/ %� PERMIT NO. /9 �BS�
SOIL TYPE an Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, otal 1 gth
Length of each trench
Depth of trenches ' k I .
Size of gravel_
SEEPAGE PITS{Number f�
Size- � ft. X
Gravel size 49"
PIPING: Size Type
Bldg. to tank
Tank to dist. bo
Dist. box to fi d/p' !�
Openings seale S NO Partial
LOCATION/SEP TIONS:
Foundation t tank �ft.
Foundation to absorption 3y ft.
.Absorptionto lot line eft.
Separatio,' of pits ,1 ft.
LOCATION✓OF SYSTEM ON PROPERTY(ci_rcle one)
Front -` Rear - Left side`_Right side -
COMMENTS:
1`
SYSTEM USE APPROVED C E NO
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