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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Dace February 8 19 21
Thin is to certify that work requested to be done as shown by Permit No. 91-023
has been completed.
Thia°structure may be occupied as a ~9e 8lterdtion
Locarion ~ Omen Avenue
Owner Joseph S. Dybas
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. 6c Code Enforcement
i
PERMISSION is hereby granted to JOSeph $. DybaS
OWNER of property located at 30 Owen Avenue Street, Road or Ave.
TOWN OF QUEENSBURY No. 91_023 ~.
WARREN COUNTY, NEW YORK
in the Town of Queensbury, To Construct or place a $e1MaAe Al terdtion
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
$allle
2. CONTRACTOR or BUILDERS Name
Bill Threw
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction - (Please indipte by X)
( 1 Wood Frame ( )Masonry ( 1 Steel
7. PLANS and Specifications
No. SeMage alteration as per plot plan specifications and application
to include: 2 seepage pits each 8' x 8' with #2 stone, 9' thickness
8. Proposed Use
SeMrage alteration
BUILDING PERMIT
$ 25.00 PERMIT-FEE PAlD -THIS PERMIT EXPIRES January 29, ~s 93
(If a longer period is required an application for an exteruion 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.
Day
~s 91
SIGNED BY
Building and Zoning I
the Town of Queensbury
TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PE4 ,./
Iv-Amv zR, q1
DATE: 3 C
LOCATION OF PROPERTY FOR INSTALLATION ;') 0 Oct-Pnf Atom rQ e ,
s_v 4 RECEIVED
.\Owner' s Name: a C y �S
Address: 3 (7 o ik,-e.1&__, Vie-- JAN 24 1991
Installer' s Name: (,-et.t maSi ° 3 fF fPPT
Number of bedrooms (residential only) 3
Total daily flow (compute @ 150 gal per bedroom) 'cD --L-
Topography: Circle one: Flat Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand Loam Clay Other /Depth:
Ground Water: At what depth? rA evk ore 30 .gym
Bedrock or Impervious Material : At what depth? jJ'Oi-' Feet
Percolation test: Circle one: not required required
Rate - Min. Per Inch
Domestic water supply: Circle one: Municipal Well Other
If domestic water supply is a. wel .
Separation: Water supply from any septic absorption feet.
Q
PROPOSED SYSTEM: Septic Tankiaiymti(. ��� gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of /Size each g feet
by feet
Size of stone to be used #)-.. /Depth or Thickness 9) feet
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HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal .
*Alarm system 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 of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSO c \ ATE:2 q /
•
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 co 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 Inspuctor. 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 installa—
tion, alteration or repair of an approved system, a new proposal muse
be submitted to th_e Queensbury .Building Department before further
construction.
•
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
• Queensbury. New York 12804
kiamarks:
.own of Queeniur1
BUILDING and ZONING DEPARTMENT •
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTI DISPOSAL SYSTEM INSPECTION
NAME t.�
LOCATION 06 26 ,
DATE 4/ / 9/ PERMIT NO. 9i-0a3
SOIL TYPE - Loam - Clay - '
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM: • •'
Absorption field, total length /
Length of each.trench /
Depth of trenches ' . /
Size of gravel / •
SEEPAGE PITS4Number of) ' 0Z, /
Size- g ft. X 87; ft. v1 -� •
Gravel size , # i{'1 /
PIPING: `\ Size(7 Type
Bldg. to tank , e?c,,l'r-". -_____
Tank to dist. box 4Lif PVC
Dist. box to field/ 't / `i,
Openings sealed? 'YES` NO Partial
LOCATION/SEPARATIONS: /•
Foundation to tank f ft.
Foundation to absorption\ ' ft.
Absorption to to , line 1\ la ft.
Separation of pits 'pip ft. '
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front4 ear r Left side -,Right side -
COMMENTS:� '
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SYSTEM USE APPROVE, , ES l/ •
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