92-401 C TIFICKrE OF COMPLIANCE
TOWN OF QUEEMSBURY
WARREN COUNTY, NEW YORK
Date , 19
This is to certify that work requested to be done as shown by Permit No. 92m401
has been completed.
This structure may be used as a Septic Alteration
Location 7 Pinericod
Owner Robert Fraser
By Order of Town Board
WN OF QUEENS RY
Director of Building Code Enforcement
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BUILDING PERMIT
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TOWN OF QUEENSBURY
No. 92-401
WARREN COUNTY, NEW YORK co
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PERMISSION is hereby granted to Robert Fraser
OWNER of property located at 7 Pinewood Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Septic Alteration Q
at the above location in accordance to application together with plot plans and other information hereto filed and CD
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address islu
Same
2. CONTRACTOR or BUI LDER'S Name
Queensbury Sewer
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3. CONTRACTOR or BUILDER'S Address rp
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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
#3 stone, 2' Thickness as per plot plan specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES July 7_ 19 94
(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 t—is
o , 19g2
SIGNED BY for the Town of Queensbury
Building and Zoni nspector
TOWN OF QUEENSBURY o
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
Fee Paid
Date: Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: / lie 1
Owner' s Name: r a
Owner' s Mailing Address:
Installer' s Name: k CEU3 Phone #: -1 -aF3� � d
Number of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 gal . per bedroom): O
Topography-Circle One: 9SD Rolling Steep Slope % of Slope
t oVirQ OF QUEENNNi-,
Soil Nature-Circle One: Sand' Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
JUL 6199Z
Bedrock or Impervious Material-At What Depth? Feet
13LDG. & C0QE Dj5PT.
Percolation Test-Circle One: Not Require Required/Rate Min. Per Inch
Domestic Water Supply-Circle On Municipa Well Other
If domestic water supply is e -
Separation: Water supply from any septic absorption feet
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PROPOSED SYSTEM: Septic Tank ilo-0-0 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: # -2 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.
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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: <S Z
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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TOWN OF QUEENSBURY
BUILDING' DEPT.
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Jown o f QueenAury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME Z�0��?/l mil/,Z/1 ,s
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LOCATION / �l/J''���
DATE �/ ,;Z PERMIT NO. %Z-��Z _
SOIL TYPE -(San -- Loam - Clay -
Percolation est Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of%,each trench
Depth of trenches
Size of grav�,el
SEEPAGE PITS{Number Of)
Size- _Kjt.�X _J3�/ft. s-.R
Gravel size rr3 v�-4
PIPING: Size Type
Bldg. to tank
Tank to dist. boxk
Dist. box to f iel,`
Openings sealedrONS- ".\
@ NO Partial
LOCATION/SEPARA �
Foundation to ��nk .uS�ft.
Foundation to absorption' `, ft.
Absorption to of line `',,� I S ft.
Separation of/pits _ft.
LOCATInYSTEM ON PROPERTY(circle one)
Front - Left side - Right sideCOMMENJ
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SYSTEM USE APPROVED O
Bui in Ins:' ector Z
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