1991-175 •,•1
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date A-5- 19 17
This is to certify that work requested to be done as shown by Permit No. 91-175
has been completed.
This structure may be occupied as a Septic alteration
neati90 riichician Avenue
Owner John Tel
By Order Town Board
TOWN OF QUEENSBURY
_ - -
/
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY 4 a
No. 91-175
WARREN COUNTY, NEW YORK
0
PERMISSION is hereby granted to John Teleski
OWNER of property located at Michigan Avenue Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Septic Alteration J
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
Smith's Excavating
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3. CONTRACTOR or BUILDER'S Address
Ci
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4. ARCHITECT'S Name —"
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( 1 Wood Frame ( ) Masonry ( )Steel ( ) r
7. PLANS and Specifications 3:2+
Septic Alteration to include:
No. 150' Tile Field with #2 stone, thickness 8"
0
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID—THIS PERMIT EXPIRES April 10, 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 --10lth Daly of`/April 19 91
// ,
SIGNED BY for the Town of Queensbury
Building and Zoning Insfaector
TOWN OF Q UE NS P UR Y TOWN OF OUEENSBUiff
APPLICATION FOR axggavi
El.
-�,AS > SEPTIC DISPOSAL PERMIT APR 101991
IMP
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BUILDING & CODE DENT.
DATE 9/9A/
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LOCATION OF PROPERTY FOR INSTALLATION ,4/c/<'7� A
r.
Owner's Name: UN')/1
�`/ /� / �/
�,( ')I') /�;Ir-sSA. Telephone: (/33 5 7
Address: Ad)! 61!, /ram
Installer's Name: 5j'1//l1/ i-xcau kl a '�k/
J Telephone:
Number of bedrooms (residential only)
Total daily flow (compute (a 150 gal per bedroom) • e )
Topography: Circle one: 4210 Rolling Steep Slope % of Slope
Soil Nature: Circle one:eSand Loam Clay Other /Depth: Feet
Ground Water: At what depth? Feet
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle one:`dot requirequired rate min. inch.
Domestic water supply: circle one: n pa Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM: Septic Tank %6d(f gal. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench 6.4 dfeet/Total system length / 4J / feet
SEEPAGE PIT(S): Number of / Size each feet by feet
Size of stone to be used # /Depth or Thickness , �d feet
*************************
I have read the regulation on the reverse side of this sheet and agree r o abide by these
and all requirements of the Town of Queensbury Sanitary Sewa e Disposal Ordinance.
SIGNATURE OF ESPONSIBLE PERSON: �/// 'lr:4/ dt
DATE: �/� O EN
, f
OVERBUILDING
C D S DEP`C.
REV I EW ED�}B/ /`//A/ //)
DATE " `''
Septic System Inspections:
•
, A. All applications for septic system installation, alteration or repair,
as req'uired. 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 all 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 installa—
tion, alteration or repair of an approved system, a new proposal must
be submitted to the Queensb'ury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and 1-laviland Roads
Queensbury, New York 12804
Remarks : •
(iL)1\1. .
_town of Qunaturcy
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME E \ PSk1 �J(11h .
LOCATION ,(\C V \
�•
DATE ! //(9 PERMIT NO. 9/ ---/�:5
SOIL TYPE 41100gW Loam - Clay -
Percolation Test Required?.! YES - NO
Percolation rate - Min/Inch ;
TYPE of SYSTEM: v !
Absorption field, total length/,SC:,
Length of each trench ' b
Depth of trenches ' p2' •
a
Size of gravel _
SEEPAGE PITS*Number of) ' )
Size- ft. X ft.ft. r, t
Gravel size
PIPING: Size Type
Bldg. to tank ;
Tank to dist. box ?�/
Dist. box to field/pit`y q
Openings sealed? NO Partial
LOCATION/SEPARATIONS:
.j •
Foundation to tan /O ft.
Foundation to absorption czip ft.
Absorption to lot. line..i ,//7 ft.
Separation of pits -.- ft.
LOCATION OF SYSTEM ON PROPERTY(circle one) .
Front , Rear - Left side - Right side -
COMMENTS: f,
•
•
•
✓�
SYSTEM USE APPROVED YES
• Buil ng Inspector
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APR 101991
BUILDING & CODE DEPT.
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