1990-791 CERTIFICATE. OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Nnvarnhar 'f1 19 90_
This is to certify that work requested to be done as shown by Permit No. 90-791
has been completed.
This structure may be occupied as a:7' $ewage alteration
Location 111 Nottinaham Drive
Owner Stephen & Suzan Fisk
By Order Town Board
TOWN OF QUEENSBURY
•. 1
Director of Bldg. & Code Enforcement
A
BUILDING PERMIT
TOWN OF QUEENSBURY No. 90_791
WARREN COUNTY, NEW YORK
0
PERMISSION is hereby granted to Stephen & Suzan Fisk 03
OWNER of property located at 111 Nottingham Drive Street, Road or Ave.
•
in the Town of Queensbury,To Construct or place a Sewage 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
Robert Ellsworth rD
c
CD
3. CONTRACTOR or BUILDER'S Address
Po
N
N
4. ARCHITECT'S Name
-1
N
5. ARCHITECT'S Address
O
6. TYPE of Construction—(Please indicate by X) rt
c l-
( )Wood Frame ( ) Masonry ( )Steel ( ) 0
2
7. PLANS and Specifications
tz)
No. Septic alterations as per plot plan and specification and application
including: 250' Tile Field, #2 Stone, 1' Thickness (13
8. Proposed Use
rD
Septic alteration'
CD
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES November 21 19 92 c
-s
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the cu
town of Queensbury before the expiration date.)
0
Dated at the Town of Queensbury this 21 Day:o November 19 90
SIGNED BY J_: ✓ for the Town of Queensbury
Building and Zoning Inspector
` � (HC - Vdq,;,-ber. TOWN OF QUEENS/JURY
� j APPLICATION FOR SEPTIC DISPOSAL PERMIT
.,„(I'Lb
DATE: flO0pfl0y- �3, PC/0 $h PC(� ,r
LOCATION OF PROPERTY FOR INSTALLATION di ,' UJl 0 „0 ( �j pp i
v 1NPd`E ('�C�il ci , y
I" REC;EJVEn
Owners Name: S r1Pii Ajii 4t..`
_ Address: M 1(1 f Y 90/ (-, NOV 16 1990
Installer' s Name: o[c ri 4. zascv0(44 , Telephones
Number of bedrooms (residential only) +4
Total daily flow (compute @ 150 gal per bedroom) Coo
Topography: Circle one: Flat Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand Loam Clay Other /Depth:
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what depth? Feet
Percolation test: Circle one: not required required
Rate - Min. Per Inch
Domestic water supply: Circle one: Municipal Other
If domestic water supply is a well :
Separation: Water supply from any septic absorption MO feet.
PROPOSED SYSTEM: Septic Tank jpA 4 gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench 6-0 feet/Total system length a,s0 feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used #. :2 /Depth or Thickness / r- - feet
Fe•:
********** ** `.**************
No:) NG T, 'STEM I '., ' IRED
NO. of Ta Ics • of
*Alarm sys sociated el cal wbrk4o be ins..- - ._n approved
a9� as .,
k
I-`4have=. read the regulation on the everse side of this sheet and agree to abide
by.--these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
/ üO .SIGNATURE OF RESPONSIBLE PERSON: DATE: I /c
•
•
•
•
•
Septic System Inspections:
+
A. All appiiritions for septic system installation, alteration or repair,
as requited by the Town. of Queensbury Sanitary Sewage,.Ordinance, shall
. be submitted=-co-che Building Department at least 24 hours before star;
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 drywalls
B. Nu system shall be covered before inspection and approval by the
• Uuilding ,Inspeccor. Failure to comply with this requirement may
result in the uncovering of the system by the installer and a fine
of up to $250.00.
•
C. An approved copy of the plot plan shall be available on the construction
site. Failure co produce said plot plan at time of inspection may result in in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installa—
tion, alteration or repair. of an approved system. a new proposal must
be submitted to the Queensbury Building Department before further •
construction.
'Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads.
Queensbury, New York 12804
Remarks •
°"��.�'"'�:. MIDDLE DEPARTMENT INSPECTION AGENCY,:INC.
jNational Headquarters
1337 West Chester Pike,West Chester, PA 19380
APPLICANT COMPLETES THIS SECTION Date: /J , ...
City, Town or Township '(. ; _ /`, --� County LUG r- ,/ t-G c I State /17(f
Location/Address l'. ( -.-•f-- . ._ 4, , r; .r'" ' ..
R(If Located,inRural Area-pease Attach Directions) Pole #
Owner 17 ---('%—' ��� Permit #
Occupied As - F %, -f- , C ` \/'7 -1.1 Building:, New❑ . Old
Occupant -
' Work Area in Building (Floor #, etc.):
App. for: Wiring❑- ' ervice❑ or: Ready for Inspection:
Fee Remitted-$ Cash n Check n M.O. n Make Payable To: M.D.I.A.
500 750 1000 1250 1500 1750 2000 2250 2500 2750 3000
Number of Rough Wiring Outlets Elect. Heat
Switches
Lighting Amp. Service Surface Unit Dishwasher Range
Receptacles Water Heater Air Conditioner Dryer Pump
Number of Fixtures Oven Garbage Disposal Wiring and Controls•,for. Burner
Amp. Receptacles Fractional H.P. Vent Fans : t
Other Equipment: .
MOTORS H.P. 1/201/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4 1 11/2 2 3 5 71k 10 15 20 25 30 40 50 75 100
Mark Number
of Each Size
Applicant's
Signature / License # Permit #'
T/A j7 , - j 6--C /� t\4 C.(-�4-' ( Utility:
(NAME) (OFFICE LOCATION)
Applicant's Address: .ice:--. f.- /-I. j -_'- ,h r`
(City) . „ ,-4, C-f_ (State) /7 ' (Zip) '2„l•) 3 Service Request #
Phone # /f 'S Electrician: -
MDIAUSE ONLY DATE RECEIVED: / / �)-/a. �_ DATE INSPECTED: , f r_ z/ >
Correct Location: Same as Above n or: .
Red Notice Label n
Rough Wiring Outlets Surface Unit Oven
Switches Range - Garbage Disposal
1 Receptacles C:-7 ,C!.❑, Water Heater Dishwasher
Fixtures Air Conditioner Dryer '
Amp. Service Equipment Burner, Wiring &Controls for Amp. Receptacle -
Amp. Service Conductors Pump Vent Fans
MOTORS H.P. 1/20 1/12 1/10 1/8 1/6 1/4 1/3 1/2 3/4' 1 11/2 2 3 5 71/2 10 15 20 25 30 40 50 75 100
Mark Number
of Each Size
• a
500 -750 1000 1250 1500 1750 2000 2250 2500 2750 3000
Elect. Heat
•
1 ton '-3 '� r !--! , 11. ;:' ,-.1 ,_ i .- in I /..7,) I. >
IJ
CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE CORRECT FEE FEE PAID
❑ RW Progress: Inc.CI LKD❑ • Contractor
I 4-I--tFT Violation: Work Comp.❑ Inc. ❑ Vtb
n L/A Owner CASH ❑
Fee CH K #
n .L/A. - - - Due -
n IPA V. Municipal MO #
- INV #
Date: /7 r? OtherSide ElApplicant ElUtility Owner ❑
Cut in Card PI Temp # Date fit ( l
Final # Date INSPECTORS SIGNATURE
- APPLICATION FORM NO.250 EL 11/89
cc /T� 7 /`1 -
Jown of Queenibur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
•
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME r/
LOCATION orr A/6 /4 aAA
• rfd /
1 f Z DATE_ % 90 PERMIT NO. 90'17 (
SOIL TYPE - Sand - Loam - Clay - •
Percolation Test Required?; YES - NO
Percolation rate - Min/Inch - rI
TYPE of SYSTEM: Vrr
Absorption field, total length , '
•
Length of each trench'
Depth of trenches ; -3
Size of gravel"_
SEEPAGE PITS*Number of)
Size- ft. X ft. /
Gravel size
PIPING: Size f21
Bldg. to tank • Jy�
Tank to dist. box 4l `i 9
Dist. box to field/pit ) °/ 0/
Openings sealed? YES ;° /NO Partial
1j
LOCATION/SEPARATIONS: :' s�
Foundation to tank ;?/ ft.
Foundation to absorption _ -O ft.
Absorption to lot line!) ft.
Separation of pits i `fi ft.
LOCATION OF SYSTEM ON/PR'OPE circle one)
Front - gear - Left side'- Right side--
COMMENTS:
•
"I° 622;1A,; a4n.
•
SYSTEM USE APPROVED . NO
_ C
Bu ding Ins ector
01/86 and vl
'. � • N 89•-2/'-/0" E 1 . /25.00'
rn
•
k, •
C
4
C
0. 502 I ..
• :;,..) ,PSG i - Nov r:� c pro
i
� ese
� A R �:^,�G. & CO i 0 R
.41
v/1
-•-, It (\% S1‘. if
•
,( . . :_____,(tP.., ' , —'------..--------7T— t.:"
- 31.9' • 26.6 e
I.
2 Story Garage '
I Frame _-_ 24.6'
•
3 4.4' "_""' �' , ` . •
/' second story
0 overhang t
•03 :. . - We//cr
\ . .
el, • et
•o " M
0 - .\ 6'
ti
c
t•-: \ -0r,.._ .
J '
Roil Fence E
Z�.
0.5'Encroochmen, M o
0
c,
0
. -. --�-- ` _ _r • - •-•-'
. • - �a..: - . t
151.9' S89°-2/'-/0" W • - . /25.00'
E
•
. NOTT/NG'HAM - DR/VE
5 71 �s �br p� ��� 5 J k-LsA-4
— 16j niQSVGNHS 'V
1,4
60
'"11 S -)(Vw0 Z0