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CERTIFICATE OF COMPLIANCE ; ,,
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date December 20. 19 90
36( 1 `"] r a
This is to certify that work requested to be done as shown by Permit No.
has been completed.
s
This structure may be occupied as a SeDti c Alterationon
Location 17 Buena Vista
Owner John Bulova
By Order Town. Board ",
TOWN OF QUEENSBURY
Director of Bldg. ck Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY Na 90-8ee
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to_ John Bul ova
OWNER of property located at 17 Buena Vista Avenue 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'SAddressis 17 Buena Vista Avenue
2. CONTRACTOR or BUILDER'S Name Condon' s Septic & Drain
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( 1 Wood Frame ( ) Masonry ( )Steel (
7. PLANS and Specifications
No. Septic alteration as per plot plan specification and application
including: 2 seepage pits 8' x8' Stone size #3 Thickness 2'
8. Proposed Use
Septic alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES December 18, 19 92
(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 18th Day of DECEMBER 19 90
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
-- r�--roes• —u�r l\ ( ',CO -J
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,� �� APPLICATION FOR ;rj
-.-1li 17.- r
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SEPTIC DISPOSAL PERMIT
DATE / '& i7 — U
LOCATION OF PROPERTY FOR INSTALLATION / / G O e fU 6 Vls +A AV 6,
t--Owner's Name: t) p h fU f- l9 /0 VA Telephone: 7 l 3 /3
Address: 17 B U E ru V f S` 4 All E
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Installer's Name: ( fU 3 a F k C, -D RA (Ai Telephone: s7 G ?- V
Number of bedrooms (residential only) 3
Total daily flow (compute Cd 150 gal per bedroom) 9 S 6
Topography: Circle one: Fla Rolling Steep Slope % of Slope
Soil Nature:Circle one:CP Loam Clay Other /Depth: Feet
Ground Water: At what depth? `N/ Feet
Bedrock or Impervious Material: At what depth? iV/A Feet
Percolation test: Circle one: not require required rate min. inch.
Domestic water supply: circle one: Cunicipal)Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
ES-1-u,115'
PROPOSED SYSTEM: Septic Tank JO 0 0 gal. (minimum size: 1.000 gal.)
TILE FIELD: Each Trench feet/Total system length • feet
SEEPAGE PIT(S): Number of 2_ / Size each R' feet by g feet
Size of stone to be used #3 /Depth or Thickness pl feet
*************************
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 ewage Disposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: ("
DATE: ().--" 17-- ? U
OVER
•
• 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 •
•
8. Nu 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
uf. up to $250.00. -
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may
result in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installa—
tion, alteration or repair of an approved system, a new proposal must •
be submitted to the Queensbury Building .Department before further
construction.
•
•
Town of Queensbury
BUILDING-and-CODES DEPARTMENT
Bay'-and Haviland Roads
Queensbury_, 4ew York 12804
•
Remarks: •
ter` v� Pi)
Joeun Of Queeniur i$V
BUILDING and ZONING DEPARTMEN
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
•
SE,(PPTTICI DISPOSAL SYSTEM INSPECTION
NAME \Jl)IFr 12/)
LOCATION 1 e u e 116 0.S�T
DATE / 9- // PERM NO. - o_ / d
SOIL TYPE - Sa d - oam - Clay -
Percolation Te,t. quired? YES - NO
Percolation rat: ` Min/Inch
TYPE of SYSTEM: ,
Absorption field . a length
Length of -- ; re Bch
Depth trenc es
Si - of gray. / 4a
SEEPAGE PITS{{ umber of) o[._
Size- ft.t X Q" f4\
Gravel size .11
PIPING: §ize Type
Bldg. to tangy 1ST/xi-6
Tank to dist, box kif Pry
Dist. box t• field/.. p�J
Openings sealed? NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption ft.
Absorption to lot line ft. '
Separation of pits ft.
LOCATION OF SYSTEM ROPERTY(circle one)
ront - Rear - eft side Right side -
ENTS:
•
•
SYSTEM USE APPROVED YE 0
1N7 •
Bui1 ing ns ector
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