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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Ma V 6 19 91
This is to certify that work requested to be done as shown by Permit No. 91-102
has been completed.
This structure may be occupied as a Septic alteration
Location Courthouse Drive
Owner Frank C. Shortell
By Order Town Board
TOWN OF QUEENSBURY
Director of.Bldg. & Code Enforcement
BUILDING PERMIT
• TOWN OF QUEENSBURY
No. 91-102
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Shortel l , Frank C. w
OWNER of property located at Courthouse Drive Street, Road or Ave.
w
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
Hometown Sewer Service r,
3. CONTRACTOR or BUILDER'S Address 0
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4. ARCHITECT'S Name
C7
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) fD
( 1 Wood Frame ( 1 Masonry ( I Steel ( )
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7. PLANS and Specifications -�
No. Septic alteration to include 1,000 gal tank, 260' Tile Field as per a,
plot plan specifications and application r
8. Proposed Use
Septic Alteration 0
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES March 19, 19 93
(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 __-190 Day of , March 19 91
SIGNED BY � �i for the Town of Queensbury
Building and Zoni 'Inspector
TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT )
_ J
DATE: 3/ /Y \''/P
LOCATION OF PROPERTY FOR INSTALLATION Cw/2/40(_, 172/4/4tIrrn 'zsti 44
Owner's Name: ,44)< _5-664—my_
Address: 61ci/L7h,,(Jc 121, Lie i6, ff, Ai• }/.
Installer' s Name:f0d1E/e O�f � czied_�Se%G'�Ico /Telephone: 4a3 -2 9:-(3
Number of bedrooms (residential only)_
Total daily flow (compute @ 150 gal per bedroom) �eG
Topography: Circle one: 40 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 Well Other
If domestic water supply is a well :
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank /m" gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench e feet/Total system length ,74;..O feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used #.. /Depth or Thickness feet
*****************************
HOLDING TANK SYSTEM IF REQUIRED
NO of Tanks Size of Each Gal .
*Alms 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✓ ,;,;kf 2 ==;i1 DATE: / /e %./
37, - y-_3
•
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 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 co 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
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 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_ repuir of an approved spite*, anew proposal_.must
be submitted to the Queenabury Building Department before further
construction.
Town of Queenabury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queenabury, New York 12804
li%:marks: •
TOWN OF QUEENSBURY
xf u' 531 BAY ROAD
k,* QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447
BUILDING INSPECTOR'S REPORT ,
FINAL INSPECTION
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION 41,7✓ (rti� cg
DATE 8 9/ PER1ITO
TYPE OF STRUCTURE V • ,GCS e/
RECHECK
FIRE MARSHAL APPROVAL (COMMERCIAL STRUCTURE)
FOOTING FOUNDATION BACKFILL FRAMING
ROUGH PLUMBING FINAL ELECTRICAL _SEPTIC
INSULATION WOODSTOVE/FIREPLACE
REMARKS
APPROVAL
N/A YES NO
CHIMNEY HEIGHT/LOCATION
B VENT/LOCATION 1
PLUMBING VENT
ROOFING
SIDING
DECK/PORCH/STEPS/ AILINGS
RELIEF VALVES
FURNACE/HOT WATER ORERATING
BASEMENT INSULATION/ JCTWORK /-
INTERIOR TRIM/PRIVACY QOORS
FINISH FLOORS: a
BATH/KITCHEN WATERTIGHT
OTHER FLOORS SWEEPABLE
OTHER FLOORS CARPETED "I
STAIR CLEARANCE/RAILINGS
HANDICAPPED ACCESS
SMOKE DETECTORS V
BATHROOM FANS/WHOLEHOUS' FANS
ALL PLUMBING FIXTURES OPERATING
GARAGE FIRE PROOFING
DOOR CLOSERS
OTHER FIRE SEPARATIOn 11 '1
FIRE/DEMISE WALLS �1
DUMPSTER kla
SITE PLAN/VARIANCE REQUIREMENTS
FINAL ELECTRICAL
OK TO ISSUE C/O OR C/C
COMMENTS:
/4 091,_ /4///_(_,
•
ARRIVE
DEPART
INSPE TOR
•
awn of Queeniurcy
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
•
SEPTIC DISSPOSAL SYSTEM INSPECTION
•
NAME i ,0nh •
LOCATION C:oge tX fk S 6 .
DATE 3/3 / 91 PERMIT NO. gk/dA
SOIL TYPE San Loam' - Clay - .1
PercolationRequi'red? YES - NO
Percolation rate - M4n/Inch _
TYPE of SYSTEM:
Absorption field, total length 0
Length of each trench ,rj' / :
Depth of trenches--3 � • ,r'.
Size of gravel tI Z
SEEPAGE PITS4Numberof) •
Size- ft. X
Gravel size ,
PIPING: Size: Type
Bldg. to tank 172)?` to C
Tank to dist. box ;: �} :�,�
Dist. box to field/pity ' P`/e_
Openings sealed? YES ' NO Partial
i7t
LOCATION/SEPARATIONS- \
Foundation to tank -; ; jLit.
Foundation to absorption's t ft.
Absorption to lot/line �` ' Loft.
Separation of pit/b ft.
TION OF SYSTEM ON. P:.PERTY(circle one)
- Rear - Left sid- Right side -
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SYSTEM USE APPROVED NO
Bui ing Inspec r
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