91-551 i -
r°
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date .PI�O /� 19 �
This is to certify that work requested to be done as shown by Permit No.
has been completed.
This,
structure may be occupied as a Septic alteration
Location OR Box 333 Sherman Islands Rd
Owner Jams Orapalla
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. do uCode Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-551
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to James-.0rgpallo
OWNER of property located at REIN Box 333, Sherman Island Rd 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
2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction— (Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. Septic Alteration to include: 200' of Tile Field using 02 Stone
1' Thickness
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES AUGUST 1 1993
(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 Day of AUGUST 19_91
SIGNED BY ,f/ / for the Town of Queensbury
Building and Zoning Inspe or
TOWN OF QUEENSBURY
ti APPLICATION FOR SEPTIC DISPOSAL PERMIT
DATE:— TO
LOCATION OF PROPERTY FOR INSTALLATION
IV
�j
Owner' s Name: JL( e-J- (Laj(j�) 0
L
Address:.6 7) /V erlyA,�-j /?,I
.1 ol BUILDING & COME DEPT.
Installer' s Name: J- ,4,v L1-17,,�o rlgell Telephone: 792-22-,s-�
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: Circle one: G� Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand Loam Clay Other /Depth:
Ground Water: At what depth? F Irl/*tV C
Bedrock or Impervious Material : At what depth? Z.DAf p
Percolation test: Circle one: Cn o t require rWut ce,
0A)"t
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.
PROPOSED SYSTEM: Septic Tank /oo o
_gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench -50 feet/Total system length feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used 2- /Depth or Thickness— feet
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 PERSON:4 a, ,
1,-�DATE: �-J/-_&
M
Septic -S ystsa Inspections:
A. A11":applicat1oni-'f0r septic sysces installacion, alteracion or repair,
as required by the Town of Queensbury Sanitary Sewage Ordinance, shall
br.,submiccad, co:,che Building Departmenc at Isaac 24 hours before start
cf construction, and shall include a plot plan showing:
1.) the proposed location of cho syscen
2.) locacion and distance to loc lines
3.) locacion and distance to structures
4.) locacion and distance co any water supply
5.) size and dimensions of all canks, distribution boxes,
cila--ficlds -and/or-drywalls- -
B. No system shall be covered before inspection and approval by the
Uuilding Inspuctor. Failure to comply with this requirement may
rwsult in the uncovering of the syscem by the installer and a fine
of up co $250.00.
C. An approved copy of the plot plan shall be available on the conatsuccion
site. Failure co produce said plot plan at ciao of inspection say -
rasulc in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installa-
cion, altaracion or repair of an approved syscem, a new proposal susc
bu submitced co the QucQnsbury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and HAviland Roads
Queensbury, New York 12804
JUC 1991 '
BIi1LD1111G 8 CODE Dept.
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TOWN OF PF a
REVIEw LD BY
OATS -
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Jown o/ QueenAupy' .
BUILtING and ZONING DEPARTMENT
4ay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME n�c�CL) L)-
LOCATION
, XOv) 3 33
DATE /� PERMIT NO.S) I
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rat - .Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each tr nch 5/f) /
Depth of trenches - 73 ,1 /
Size of gravel"_
SEEPAGE PITS{Nuinbek of)
Size- ft. X ft. j
Gravel size
PIPING: `� Size Type
Bldg. to tank
Tank to dist. box
Dist. box to field/pit //CJ
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank IU ft.
3D ft.
Foundation to absorpti A
Absorption to lot line
Separation of pits ft.
LOCATION OF SYSTEM ON PROfERT �c�irc�le�one)
Front - Rea - Left s'de fight sid -
COMMENTS:
X
4
�l
�t
6
SYSTEM USE .APPROVED YES NO -
BuAlding In pector
01/86 and vl
pv
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