1991-159 f.
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Apr'/ q 19
This is to certify that work requested to be done as shown by Permit No. 91.-1,5q
has been completed.
This structure may be occupied as a Septic alteration
Location .2 Gilmore Avenue
Owner Alan E. fter°cuare
By Order Town Board
TOWN OF QUEENSBURY
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Director of Bldg. & Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBURY X
No. 91-159
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Alan E. Mercure
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OWNER of property located at 2 Gilmore 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. CD
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1. OWNER'S Address is
Same
2. CONTRACTOR or BUILDER'S Name a
Same
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
6. TYPE of Construction— (Please indicate by X)
( )Wood Frame ( ) Masonry ( ) Steel ( )
7. PLANS and Specifications
No. Septic alterations to include 1 seepage pit 8' x 8' , size stone #2
as per plot plan specifications and application
8. Proposed Use
Septic alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 9, .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 Day of,., April 19 91
SIGNED BY / ��� /r � for the Town of Queensbury
Building and Zoning Inspector
OftTOWN OF QUEENSBURY
lg #j APPLICATIONFOR SEPTIC DISPOSAL PERMIT cS7
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DATE:
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: r .,,.a f
Address: -��1��,���P
Installer' s Name: , Telephone: .fi3-
Number of bedrooms (residential only) 3
Total daily flow (compute @ 150 gal per bedroom)
Topography: Circle one: Rolling Steep Slope % of Slope
d_— Loam- Clay- —Other - /Depth: - _
-- ---- --Soil—Nature: --Circle—one:- -S'4-Sand - - ---- - -
,
Ground Water: At what depth? f., Feet
Bedrock or Impe ivr ous 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 wel
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank ,00 O gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
; SEEPAGE _ . PITS: Number of /Size each feet
by feet
Size of stone to be used #.. /Depth or Thickness Y X E' feet
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HOLDING SYSTEM IF REQU
NO. of Tanks Size of Each
*Alarms s and associ electrical work to spaded by an approved
a
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: :Lelt_e_ALrY°tc..Ceuz - DATE:
DC,-Q'.0 'llIll.gt , eirdai ))
. Jotun .o/ Queenihu9, 67-3 .
BUILDING and ZONING DEPARTMENT
Bay and Havitand Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME NoLArs„ 6-M , 0.0 ✓ -e
LOCATION - C)') I}�j '�r'' e'..� --{�Q�
DATE 2/ / PERMIT NO,' 9 J ll5�
SOIL TYPE - Sand - Loam -2' Clay -
Percolation Test Required? YES - NO)
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench'
Depth of trenches
Size of gravel
SEEPAGE PITS{Numb of) )`; t;
• Size- ,----- ft. X )ft. L ( . .
Gravel size ,e 3
PIPING: Size' Type
Bldg. to tank ii,,/; .
Tank to dist. box ;':
Dist. box to field/pit ,/% '/ %.e.
Openings sealed? YES/ NO Partial
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LOCATION/SEPARATIONS:P
Foundation to tank ::� ft.
Foundation to absorption • ft. .
Absorption to lot jline L ft.
Separation of pith ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side.- Right side -
COMMENTS:
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/te217.1plya /0 O. /(,.
SYSTEM USE APPROVED 40 NO
B ding In ector
01/86 and vl
IlptiC System Inspections,:
A. All applications for septic system installation, alteration or repair,
as required by the Town of Queensbury Sanitary Sewage Ordinance, shall
bye 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,
rile fields and/or drywalls
B. Nu system shall be covered before inspection and approval by the
Uuilding Inspuccor. Failure to comply with this requirement may
rgsulc in the uncovering of chd 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 say
rusulc in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper lascalla—
cion. alteration or repair of an approved system, a new proposal must
be submitted co the Queensbury Building Department before further
construction.
Tosco of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads •
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Queensbury, New York 12804
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