1991-359 •
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Thew 3i19 'gI�
This is to certify that work requested to be done as shown by Permit No. 91.e359
has been completed.
This structure may be occupied as a Semi t• Al t.mm i t eel
Location11 Greenwood Lane
Owner Dr Ron Del Signore
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By Order Town Board
TOWN OF QUEENSBURY
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Director of Bldg. do Code Enforcement
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BUILDING PERMIT
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TOWN OF QUEENSBURY
No. 91-359
00
WARREN COUNTY, NEW YORK
1-1
PERMISSION is hereby granted to Dr. Ron DelSignore
OWNER of property located at 11 Greenwood LAne 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 o
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
Same
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2. CONTRACTOR or BUILDER'S Name r�D
Sanitary Sewer
3. CONTRACTOR or BUILDER'S Address
CD
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4. ARCHITECT'S Name r
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5. ARCHITECT'S Address •tp
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6. TYPE of Construction— (Please indicate by X) fD
( )Wood Frame ( ) Masonry ( ) Steel ( )
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7. PLANS and Specifications
No. Septic Alteration to include: 2 seepage pits each 8' x 8' using
03 Stone, 2' THickness
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES flay 29, 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.h' 29th,-i Day of May 19 91
SIGNED BY ‹-- ✓G'"t: �/ /I%�� for the Town of Queensbury
Building and Zoning Inspector
/n ► Tt� N OF QUEENSBURY � 7 r
9 APPLICA A (I ' 't Pi DISPOSAL PERMIT
TOWN OF QUEENSBWRY
n RECEIVED
DATE: " Y - 7/ �✓'
LOCATION OF PROPERTY FOR INSTALLATION ( ` GePlvwn�JAY E8/4--PP2
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Owner's Name: tt p 0,0 41 0/LE BLDG. & CODE DEPT.
Address: 1 ...-Cetuck.,0
Installer's Name: c/ J1Tn /56v2_4_ Telephone: 7 9) - 7.,5-`2
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) So
- Topography: Circle one: Rolling Steep Slope % of Slope
Soil Nature: Circle one •
Loam Clay Other /Depth:
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what depth? Feet
Percolation test: Circle one: not require required
Rate - Min. Per Inch
Domestic water supply: Circle one: 421211MIlk Well Other
If domestic water supply is a wel
Separation: Water supply from any septic absorption feet.
£KI SST i"Sa
PROPOSED SYSTEM: Septic Tank tbo gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of ea /Size each P' feet
by 9- feet
Size of stone to be used # /Depth or Thickness Z feet
*****************************
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 PERS : DATE: 4Pr /?
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Septic System Inspections: •
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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 proposed location of the system •
2.) location and distance to lot lines
3.) location and distance to structures
4.) location and distance co any water supply
— — ---- =5.)—size--and---dimensions- of—a.11—tanks,---diser-ibue-ion--boxes-, -
tile fields and/or drywalls
B. Nu system shall be covered before inspection and approval by the
Building Inspector. Failure to comply with this requirement may
r . ulc 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
site. Failure to produce said plot plan at time:.of inspection say
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
bi submitted co the Quae nsbury Building Deparcmonc before further
construction.
• Town of Qusensbury
BUILDING and CODES DEPARTMENT •
Bay and Haviland Roads
Queensbury, New York 12804
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_own o/ Queenitur,'
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
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SEPTIC DISPOSAL SYSTEM INSPECTION
NAME t 4-L tSri kg)9J-
LOCATION /I 6 ,JWC)16
DATE 5/..3)/ '?( PERMIT NO. /( 3
SOIL TYPE - and oam Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total
Length of e c ch
, Dept trenches ' /
ze df gravel' 7
SEEPAGE PITS4Number of) /`
Size- ft. X ft/
Gravel size • 5
PIPING: \ / Size Type
Bldg. to tank
Tank to dist. box /\ (I) v(._
Dist. box to field/pit 4 WC1
Openings sealed?/ YES\ NO Partial
LOCATION/SEPARATIONS: \
Foundation to:,'tank \Q[C ft.
Foundation to' absorption _ N ft. 0 J(
Absorption to lot line `eft
Separation of pits f,2
LOCATION OF/SYSTEM ON PROPERTY(c'ircle one)
Front - cam Left side - Right side -
COMMENTS:
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SYSTEM USE APPROVED Y N
Build in spector
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