1991-200 ehs-
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
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Date �%/�i1/f /f 19 e%
This is to certify that work requested to be done as shown by Permit No. 91-200
has been completed.
This structure may be occupied as a Septic Alteration
I.neation RDP1 Box 288 Surnvside Rd
Owner Curtis & Cynthia Guardiola
By Order Town:Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY X
No. 91-200
WARREN COUNTY, NEW YORK v
O
PERMISSION is hereby granted to Curtis & Cynthia J. Guardiola
OWNER of property located at RD#1 Box 288 Sunnyside Rd Street, Road or Ave. 1.1
Co
in the Town of Queensbury,To Construct or place a Septic Alteration .p
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 a
CL
Same O'
2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer Service
N
Re
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
V)
5. ARCHITECT'S Address
CD
6. TYPE of Construction-(Please indicate by X)
GAL
( )Wood Frame ( ) Masonry ( ) Steel ( )
V)
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7. PLANS and Specifications
•
No. Septic alteration to include: 1000 gal . septic tank w/2 seepage pits
each 8' x 8' w/#3 Stone, 2' Thickness as per plot plan specifications and application
8. Proposed Use
a
r
-a.
Septic Alteration 0
$ 25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES April 17, 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 17th Day of.. April 19 qi
SIGNED BY � ✓�s �it_�L-- for the Town of Queensbury
Building and Zoning Inspector
/�► TOWN OF QUEENSBURY F t
41r.t4 APPLICATIOfi FOR SEPTIC DISPOSAMNSIM QUEENS&JRY
RECEIVED
DATE: ✓ I l f n ( I APR 161991
LOCATION OF PROPERTY FOR INSTALLATION
' ODE DEFT,
Owner' s Name: �� � �f rdr dlo.
Address: G1 b
Installer' s Name: ��� SZA,`,A,t S(u,•LA Telephone 9z_ AS1
Number of bedrooms (residential only) 3
Total daily flow (compute @ 150 gal per bedroom) -Z-/S (
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 411, Other
If domestic water supply is a well :
Separation: Water supply from any septic absorption (v O 1 feet.
PROPOSED SYSTEM: Septic Tank / fi gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of /Size each feet
by ,y feet
Size of stone to be used /Depth or Thickness feet
r****r***********************
HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal .
• *Alarm 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: o -4
•
- 5±otis System Inspeccions:
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 lease 24 hours before start
of construction and shall include a plot plan showing:
1.) the propostd location of tho system
2.) location and distance co 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.
the fields and/or drywalls
B. Nu system shall be covered before inspection and approval by the
uuilding Inspuctor. Failure to comply with this requirement may •
rwsulc in the uncovering of the syscem by the installer and a fine
ui up co $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
rusulc in an immediate work stoppage.
•
D. Should unforeseen problems during construction prevent proper installs-
cion, alteration or rup. i.r of an approved system, a new proposal must
bu submiccad co the Qu.eunsbury Building Departmonc before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT
- Bay and Haviland Roads
Quaensbury, New York 12504
k.alarks: •
., we-cQ 9 p ni
.,. •
. .
. ,
_la& vn of Queen ' urf/
EiUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION •
NAMED O v A 0 4 . u'14- `Jui 11p1\A
LOCATION U1`1n ,C'A• -__ (` (�
-7 DATE 1-1 / / / PERMIT NO. 9 1 -4 6
SOIL TYPE Sand - Loam - Clay -
Percolation -- •equired? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM: ?
Absorption field, total length
Length of each trench '
Depth of trenches '
Size of gravel _
SEEPAGE PITS4Nuinbe f) -.,1
Size- ft. X eft. /
Gravel size , 3 r"
PIPING: Size Type
• Bldg. to tank "'
Tank to dist. box s, A+"
Dist. box to field/pit'
Openings sealed? YES NO Partial
`
LOCATION/SEPARATIONS:
Foundation to tank a-bft.
Foundation to absorption Soft. . •
. Absorption to/lot line e ft. .
("p
its
pits oft.
LOCATION OF' SYSTEM ON PROPERTY(circle one)
Front - Rear Left side Right side
COMMENTS,:
, ,./ .
. , _ __. F-'/I- Of-4 • .
./ ey_bsa:e7c--?4, .
•
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SYSTEM USE APPROVED YES
lding In ector
01/86 and vl •
' eto/5-, 0-y L/i✓_F
TOWN OF QUEENS8URY L
RECEVED
APR 161991
BLDG. & CODE DEPT.
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TOWN OF QUEENSBURY
FAsr • .1 --- ' --- --CODES—DEPT__ -_� DD-'-1
REVIEWED B . vim
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