1991-326 .^ +1 ,i% _.. ti. 3 _ `49 ,fie.. _ _ ..'a,,. '--• - ' • ,
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date /-17/vz_ ,641 19
This is to certify that work requested to be done as shown by Permit No. 91.-3?
ti
has been completed.
This structure may be occupied as a Septi alteration
Location 97 Lo;.,w,rr Dix Avenue
Owner Thomas F. Keeley
By Order Town Board
TOWN OF QUEENSBURY
I
Director of Bldg.. do Code Enforcement
i'f
BUILDING PERMIT
TOWN OF QUEENSBURY No 91-326
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Thomas F. Keeley
OWNER of property located at 97 Lower Dix Ave. 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.
1. OWNER'S Address is
Same
2. CONTRACTOR or BUILDER'S Name
Ron Dufore
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( I Wood Frame ( ) Masonry ( ) Steel ( )
7. PLANS and Specifications
Septic alteration to include:
No. 1,000 gal Tank with 2251.. of Tile Field using f2 Stone, 1' x 2"
Thickness
8. Proposed Use
Septic alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 20,:- 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 20th Day. f May 19 91
.�SIGNED BY for the Town of Queensbury
Building and Z ing Inspector
Avj TOWN OF QUEENSBURY G� _
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # I / 3(7 -(D
Fee Paid ",n(`)
Date: ) // Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: 97 x /)Jk /1
Owner' s Name: 7j{7t� 2,+4S i T A 793- 20
Owners Mailing Address: 97 ZObt7e2 f)/, 467,
Installer' s Name: j /(/ i907-"D?E Phone #:
Number of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 gal . per bedroom) : 4/,56
Topography-Circle One: lat Rolling Steep Slope % of Slope
Soil Nature-Circle One: and 0. d Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: Not Required equired/ ate/(p Min. Per Inch
Domestic Water Supply-Circle One: Municipa Well Other
If domestic water supply is a we -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank 10 00 gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench 20-30 feet//Total System Length 225 feet
Seepage Pit(s) : Number of / Size each: ft. x ft.
Size of Stone to be used: # 2 / Depth or Thickness J 'AG feet
**************
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks Size of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
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.
TOWN SIGNATURE OF RES 0 SI `LE'PERSON: DATE: c5--//2/1/
REVIEWED u 17
\DATE 5//7797
Septic 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 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 $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
Town of Queensbury
Building & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks:
_loom of Queendbur,
BUILDING and ZOt NG DEPARTMENT �"e'"!
Bay and HavTland Road, R.D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEMINSPECTION
//11,
LOCATION Q/7 &% 4 xi
DATE 67 3/G/ PERMIT NO. f 3 6-
SOIL TYPE - Sand Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch/
TYPE of SYSTEM:
Absorption field, total lehgthF 3S
Length of each trench S ie 1
Depth of trenches ' l'. ,) l'
Size of gravel_ d2.
SEEPAGE PITS{Number of) .4
Size- ft. X _ ft.
Gravel size
PIPING: Si e,,, � Type
�ti
Bldg. to tank • ° .
Tank to dist. box P I'M 51
Dist. box to field/pit %i 1 4'
Openings sealed? 410 djfNO Partial
LOCATION/SEFARATIONS:
ldFoundation to tank 20-a-f
Foundation to absorption1V1 yo ft.
. Absorption to lot line I jrza ft.
Separation 'of pits I 1 ft.
LOCATION OF SYSTEM ON ROPERTY(circle one)
Front �ie )- Left side - bight side -
COMMENTS: I
0st pro4ry
•
SYSTEM USE APPROVED OF
•
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Building Inspector
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TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
Cc' c 531 BAY ROAD
o$' 'QUEENSBURY, NEW YORK 12804
:rke t 4--TELEPHONE (518) 792-5832
- BUILDING INSPECTOR'S REPORT
REQUEST FQR INSPECTION RECEIVED 16/,721) 9 / /
NAME �'�'E'17N\ 11:, �f2 11V'.�(� 1 QY Y i S 1�11�1Ac
,�AV
LOCATION 7 Th l ?� 1.i-c- (U/
DATE PERMIT # q1" 5 J
c - -d -- S e-e. i Oer
TYPE OF STRUCTURE �xs r)0Y�. � ISo
'
) cooY - ov £v 6 C"rA_cs2„.- �°-
RECHECK QN\ Ck '(1v)\, () APPROVED
N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM
FREEZING FOR 48 HOURS FOLLOWING
THE PLACEMENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VEN1 &\(ENTS IN PLACE
PLUMBING UNDER SLAB
FRAMING: N
JACK STUDS/HEADER .;
BRACING/BRIDGINGS\
JOIST HANGERS de
JACK POSTS/MAIN BEAM "\
HEATING ROUGH-IN I
INSULATION:
FOUNDATION WALLS INTERIOR R
FOUNDATION WALLS EXTERIOR R- \ •
FLOORS R-
WALLS R-
CEILING R-
DUCT WORK OR PIPING IN UNHEATED
SPACES
REMARKS:
446> / /e,gcr-f2
ARRIVE
DEPART
SPECTOR