95-016CERTIFICATE OF COMPLIANCE
TOWN OF UUEENSBURY
WARREN COUNTY, NEW YORK
Date 7Anuary JG 19 9.5—
This is to certify that work requested to be done as shown by Permit No. 9' 16
has been completed.
This structure may be used as a
Location 168 BUNNYSIDE RD.
Owner JACOBS. BRIAN
TAX MAP NO. 54.-6 18
SEPTIC ALTERATION
By Order of Town Board
TOWN OF QUEENSBURY
Director of Building 8 Code Enforcement
BUILDING PERMIT
VALUE $ 0
TAX MAP NO. 54.-6-18
TOWN OF QUEENSBURY
No. 95016
WARREN COUNTY. NEW YORK
PERMISSION is hereby granted to
OWNER of property located at 356 SUNNYSIDE RD. Street, Road or Ave.
in the Town of Queensbury, To Construct or place a
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
1707 S. PEBBLE BE
SUN CITY CENTER, FL 33573
2.
CONTRACTOR or BUILDERS Name
SWEET, JAY
3.
CONTRACTOR or BUILDER'SAddres
QUEENSBURY SEWER
0
4.
ARCHITECT'S Name
5.
ARCHITECTS Address
6. TYPE of Construction — (Please indicate by X)
1 1 Wood Frame ( 1 Masonry 1 1 Steel 1 I
7.
PLANS and Specifications
No. SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8.
Proposed Use
SEPTIC ALTERATION
35 January 7 97
PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(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.)
18 January 95
Dated at the Town of Queensbury this TAD aQof 19
SIGNED BY
Building and
for the Town of Queensbury
WN EENSBURY
��Permit
APPLICATION FOR SOEPTIOCFDIUSPOSAL
PERMIT
0%-0/(
Fee Paid
Date: _ - j
Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION:
Owner's
Owner's Mailing Address: Su t, 11,4
S %�(c
Installer's Name: �� ry
> -54? c
Phone #: 15P�
cCC�
Number of bedrooms (if residential):
Total daily flow (residential -compute
@ 150 gal. per bedroom):
Topography -Circle One: Rolling
Steep Slope %
of Slope
Soil Nature -Circle One: Sa Loam
Clay Other
/Depth:
Ground Water -At What Depth?
Feet
Bedrock or Impervious Material -At What
Depth?
Feet e
�"c'eo of
Percolation Test -Circle One: Not Required
a uir Rate
_Min. Per Inch,
Domestic Water Supply -Circle One: Municipal ell Other _
If domestic water supply is a well -
Separation: Water supply from any septic absorption /o-a feet
kST - + / MrA C+ ! � e c e T-A-IL
PROPOSED SYSTEM: Septic Tank gal. (Minimum size: 1,000 gal.)
Tile Field: Each Trench Cr e, feet//Total System Length co feet
Seepage Pit(s): Number of / Size each: _ ft. x _ ft.
Size of Stone to be used: # / Depth or Thickness /b - feet
**************
HOLDING TANK SYSTEM IF REQUIRE
No. of Tanks Size W 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: u e DATE:
14-1 ......
Septic Svstem 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 al 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:
Z c-+/pm
TOWN OF QUEENSBURY
BUILDING 8 CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name �') �•l CA40
Location kP S nyy-,,51` r
Date Permit #p
SOIL TYPE: Sand- oam-Clay-
Results of Percolation Test -
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTI FIELD: Total length
Length of ach trench _
Depth of tr nches
Size of ston
SEEPAGE PITS:
Size -
Stone size
PIPING: —
Bldg. to Tank
Tank to Dist. B
Dist. Box to Fi
Openings Sealed
LOCATION/SEPA
ivumoer-
ft. x
ze lype
/Pit
Yes No as rtial
Foundation to ank feet
Foundation Abso tion feet
Separation f Pits feet
Conforms per Plot Plan Yes No
LOCATION F SYSTEM PROPERTY:
(circle one)
Front Rear - Left Si - Right Side
Middle Front - Middle Raiar
COMMENTS:
T&,&1
)2�)j61V" 12's 012AW11-16s,
SYSTEM USE APPROVED: ES NO
Arrived:
Departed:`
ng
TOWN OF QUEENSBURY i�-x�--
BUILDING S CODE ENFORCEMENT
531 BAY RD., QUEENSBURY NY 12804
INSPECTOR'S REPORT: ARR" DEPART /`Zf INT�p-
REQUEST�NSPECTION RECEIVED:
NAME
LOCATION j-
DATE C PERMIT
TYPE OF STRUCTURE:
APPROVED
N/A
YES
NO
FOOTINGS PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE FOR
PROVIDING PROTE TION FROM FREEZIN
FOR 48 HOURS FOLLOWING�HE PLACE-
MENT OF THE CONCRETE.
MATERIALS FOR THIS PURPO-E ON SI
FOUNDATION WALLPOUR'i
REINFORCEMENT IN PLACE
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
PLUMBING VENT VENTS IN
CE
ROUGH PLUMBING i
PLUMBING UNDER S
FRAMING•
JACK TUDS/HEADERS
- -
BRA NG BRIDGING
-
JO ST HANGERS.
---
J CK POD/ NN B-
-
-
AIR INFILTRATION BARRIER
HEATING ROUGH -IN
INSULATION•
FOUNDATION WALLS INTERIOR R-
FOUNDATION WALLS EXTERIOR R-
_
----
---
FLOORS R-
--
WALLS R-
- --
C EILING R-
-
--
---
DUCT WORK OR PIPING IN
UNHEATED SPACES R-
-----
W,��