1991-316 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date May 21 19 91
• This is to certify that work requested to be done as shown by Permit No. 91-316
has been completed.
This structure may be occupied as a Stir Al t t'i nv
LocationRB 1 Sunnvysidc Rd
Owner Ra&ph Van Duren
By Order Town Board
TOWN OF QUEENSBURY
(----1//f7
Director of Bldg. (Sc Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-316
WARREN COUNTY, NEW YORK
RALPH VAN DUSEN
PERMISSION is hereby granted to I
rn
OWNER of property located at RD#1 Sunnyside Rd Street, Road or Ave. (JD
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 o
c
rD
2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer =
3. CONTRACTOR or BUILDER'S Address rD
r3
fD
4. ARCHITECT'S Name
e+
5. ARCHITECT'S Address rD
'S
w
0
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( ) ! 1
7. PLANS and Specifications
Septic alteration to include:
No. 1,000 Tank with 250' Tile Field using f2 Stone, 1' Thickness
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 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.' May 19 91
G/ •
SIGNED BY for the Town of Queensbury
Building and 4r'ing Inspector
�Ay�.. TOWN OF QUEENSBURY
' APPLICATION FOR SEPTIC DISPOSAL PERMIT
DATE: '—)—it E. ....,.o � QUEENSEURI
LOCATION OF PROPERTY FOR INSTALLATION Pi� l �/�i� itD
Owner's Name: P-cf?. 1/4/4 u Pe
{� E DEi
Address: All / �v,dc,tt (OA( gP BL{.)i:ti.
Installer' s Name: cJf��, �T4 � ��c�e� Telephone: 79) — 7a6-7
Number of bedrooms (residential only) .y
Total daily flow (compute @ 150 gal per bedroom) t o
Topography: Circle one: Rolling Steep Slope % of Slope
Soil Nature: Circle one: and Loam Clay Other /Depth:
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what depth? Feet
Percolation test: Circle one: CrOt 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 J v feet.
PROPOSED SYSTEM: Septic Tank 1 0®-0 gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench � feet/Total system length i c feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
trOW i ;,�,�c, pE ' /Depth or Thickness /I feet
l 1f? COD s E P *************************
REVIEWED BY HO ING TANK SYSTEM IF REQUIRED
DATENO. o Tanks '" Size of Each Gal .
*Alarm system and associated electrical work to be inspected by an approved
agency.
0
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: DATE: 76-9j
L
awe 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 shoving:
1.) the proposed location of the system
2.) location and distance to lot lines
3.) location and distance co structures
4.) location and distance to any water supply
5.) size and--dimensions-of all tanks-, distribution-boxes
tile fields an►i/or drywalls
B. Nu system shall be covered before inspection and approval by the
Building Inspuccor. Failure to comply with this requirement may
result in the uncovering of the system by the installer and a fine
of up to $250.00.
•
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may
rusult in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installa—
tion, alteration or r.puir of an approved system, a new proposal must
bu submitted co the Queensbury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT •
Bay and Naviland Roads
Queensbury, New York 12804
Remarks:
•
•
•
•
•
•
_Join oQ QueeniluryI ' 447
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98 .
• Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME ) / 7/QQ"..-1 ,6 (GC-G?K- /
LOCATION ,ej.., (_,,_{. ;
el
DATE/ 4/ I?l PERMIT NO. 9/-3`4
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SY'$TEM: /'
Absorption field, total length &.Sa
Length of each trench -6 '
Depth of trenches ' 02 ' ' /
Size of gravel ',2 1
SEEPAGE PITS{Number of)
Size- ft. X \ ft.
Gravel size . \
PIPING: \ Size Type
Bldg. to tank ' '/ PC
Tank to dist. box N. y ,/ c,
Dist. box to field/pit\ c// e4
Openings sealed? YES r4 NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
' Foundation to absorption ..;70 ft. .
. Absorption to lot line/ / ft.
Separation of pits \ ft.
LOCATION OF SYSTEM 0 PROPERTYJcircle one)
Front - Rear Left pide - Right side -
COMMENT GZS f 9 / '
,� Ni
I
1
ti /
SYSTEM USE APPROVED 0 4411'
0/7 7
L //__
. Bill a ' • n rector
01/86 and vl
2
Q___ /\\ 'or co
c� U d 6►
\ 3 6' • w. CC O
'T ❑ ❑ •y7. 0
Cr ors 0 CO
., -X_ -p
_ ,dri, e '
4
1-k0u3c,
a
ytU1
,(1 x..J N,i f I O'C (La 4D