1991-312 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date ` /,lv.✓ 19f
This is to certify that work requested to be done as shown by Permit No. 91 312
has been completed.
This structure may be occupied as a Senti o Alteration
Location Ohio Avenue
Owner Donald Mardi purchasing from Jeanne Crammer
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. do Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-312
WARREN COUNTY, NEW YORK c
PERMISSION is hereby granted to Donald Ward/ purchasing home from Jeanne Crammer •
cn
OWNER of property located at Ohio 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. o-
1. OWNER'S Address is ..
O.
Same
0
0
2. CONTRACTOR or BUILDER'S Name
Same
CD
3. CONTRACTOR or BUILDER'S Address
N
CD
4. ARCHITECT'S Name
CD
a'S
5. ARCHITECT'S Address O
6. TYPE of Construction—(Please indicate by X)
( 1 Wood Frame ( 1 Masonry ( ) Steel ( 1
7. PLANS and Specifications
Septic Alteration to include:
No- 1,000 tank with 150' tile field using f3 stone, 1' thickness
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT.FEE PAID —THIS PERMIT EXPIRES May 17, 19 92
(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 _lath Day of April 19 91
SIGNED BY ) for the Town of Queensbury
Building and Zoniroi nspector
AAt TOWN OF QUEENSBURY 1
4 � APPLICATION FOR SEPTIC DIRM4109tIVENSBURy
RECEIVE+"
DATE: S ytc lc/
MAY 151991
LOCATION OF PROPERTY FOR INSTALLATION p 0nd.0
BLOG. ‘ T.
Owner's Name: Y c \ cj(> � C n _ DE
Address: C))'-\ (---) Ave- Q)e-eAW-Jott
I;nstaller' s Name: % ele hone: 8 - N
Number of bedrooms (residential only) "g
Total daily flow (compute @ 150 gal per bedroom) 300 5 Gt
Topography: Circle one:ABP Rolling Steep Slope % of Slope
Soil Nature: Circle one: San Loam Clay Other /Depth:
Ground Water: At what depth? 6- Feet
Bedrock or Impervious Material : At what depth? /L! Feet .
Percolation test: Circle one: not require required
Rate - A 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 f mo gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench . j Q feet/Total system length (6Z0 feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used #. 3 ./Depth or Thickness ) 1 feet
TOWN OF QU E E N S U RY *****************************
B.'U M L,M N CODE DEPTOLDING TANK SYSTEM IF REQUIRED
REVIEWED �'^ Size of Each Gal .
`T 'ated 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: 7f7 "/g�� D/ DATE: S �� 0/
S..eeie 3Yetem Inspections: •
tic system installacion, alteration or repair,
A. Al]. applications for sop
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 -cho system
2.) location ana distance to lot lines
3.) location and distance co structures
4.) location and distance co any water supply -
5.) size and dimensions of all tanks, distribution boxes.
vile fields. and/or drywalls
B. No system shall be covered before inspection and approval by the
uuilding Inspuctor. . Failure to comply with this requirement may
rusulc in the uncovering of the system by the installer and. a fine
of up co $250.00.
C. An approved copy of the plot plan shall be available on the construction •
lice. Failure to produce said plot plan at time of inspection may - �;�
rusulc- in an immediate work stoppage. -
D. Should unforeseen problems during construction prevent proper installa—
tion, alteration or repair of an approved system, a new proposal must
bit submitted co the -Queensbury Building Department before further
construction. •
•
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads •
• Queensbury, New York 12804
k.Amarks: •
• _/own 4 Queen3Lry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME /' ,
LOCATION„0,1 �/i / / ' —
DATE ,S / PERMIT NO. �1--,),/ a-
SOIL TYPE San - Loam - Clay -
Percolation Test Required? YES - NO •
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total lengt v f.,570
Length of each trench 52,
Depth of trenches . , 3 '
Size of gravel,
SEEPAGE PITS-ENumber of) ' /
Size- ft. X .. ft. /
Gravel size /
PIPING: Sifze Type
Bldg. to tank /N QC/c-
Tank to dist. box I 4 C(
Dist. box to field/pit [i
Openings sealed? YEr NO Partial
LOCATION/SEPARATIONS ;
Foundation to tan /0 ft.
Foundation to abs rpti'on b2o ft. &cc- - .
. Absorption to lob'+ line )$ f t.
Separation of p , s ft.
LOCATION OF SYS EM ON PROPERTY(circle one)
Front - Rear - Left side ..- Right side .- - '
COMMEN ; `1
J/ A.
/1/
SYSTEM USE APPROVED YES NO
Building Insp tor
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