1991-681 •
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date Id_ -A/7-/Y'�1-e't .24 19
This is to certify that work requested to be done as shown by Permit No. 91-681
has been completed.
This structure may be occupied as a Septic Alteration
Location Otte 9
Owner Al Potenza (Hiller Hill Mall)
By Order Town Board
TOWN OF QUEENSBURY
Director.of Bldg. do Code Enforcement
•
BUILDING PERMIT ,
TOWN OF QUEENSBURY No. 91-681
WARREN COUNTY, NEW YORK a
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PERMISSION is hereby granted to Miller Hill Mall -o
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OWNER of property located at Rte 9 Street, Road or Ave. '
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in the Town of Queensbury,To Construct or place a Septic Alteration .I
at the above location in accordance to application together with plot plans and other information hereto filed and I
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. N
1. OWNER'S Address is
7 Moorwood Drive
Al Potenza
2. CONTRACTOR or BUILDER'S Name
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Condon's Septic -5
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name Xi
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VA
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) n
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( I Wood Frame ( ) Masonry ( ) Steel ( ) _ cy.
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7. PLANS and Specifications H.
Septic Alteration to include: Ci•
No. 1000 Gal Tank with 1 seepage pit 10' x 8' using #3 Stone, 2' Thickness
as per plot plan specifications and application
8. Proposed Use
Septic ALteration
$ 35.00 PERMIT.FEE PAID —THIS PERMIT EXPIRES September 26, 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 Queensbureis_..2 6th Day of September 19 91
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SIGNED BY - for the Town of Queensbury
Building and Zont Inspector
TOWN OF QUEENSBURY
APPLICATION FOR SEPT.I,CAhSP(OL-EP�ERMIT Permit # 91,6E)
RECE-IVED Fee Paid ,35; Cb
Date: Q .-- �rL SE 2 3 1991 Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION3G.Od krill i; //
Owner' s Name: A L & 7f1t/ 2
Owner' s Mailing Address: 7 00A, e ocd Qu,e,g/as zeh-y
Installer' s Name: C/,,nji ,njS S',��-��G Phone #:
Number of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 gal . per bedroom) :
Topography-Circle One: Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth:
Ground Water-At What Depth? Al/A Feet
Bedrock or Impervious Material-At What Depth? /1�// Feet
Percolation Test-Circle One: Not Required Required/Rate Mina Per Inch
Domestic Water Supply-Circle One: 0211111110 Well Other
If domestic water supply is a wel -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank /0 0 0 gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s): . Number of I / Size each: /1 ft. x ft.
Size of Stone to be used: # 3 / Depth or Thickness } 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.
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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: i51,41
N (3P44. Pq/ DATE: Yi`D--S----9/
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:
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