1991-431 ---
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CERTIFICATE OF COMPLIANCE •
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 71 9 ez
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This is to certify that work requested to be done as shown by Permit No. 91-431
has been completed.
This structure may be occupied as a Septic Alteration
43 Caroline Street
Location
Peter Temeles
Owner
By Order Town Board
TOWN OF QUEENSBURY •
Director of Bldg. & Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBURY 1-431
No. 9
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Peter Temel es .
OWNER of property located at 43 Caroline Street Street, Road or Ave. OD
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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.
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1. OWNER'S Address is CD
Same
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2. CONTRACTOR or BUILDER'S Name
Queensbury Sewer
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address �•
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6. TYPE of Construction-(Please indicate by X)
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( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. Septic alteration to include: 120' of Tile Field as per plot
plan specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES June 20, 1g 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 2 0th Day of � June 19 91
SIGNED BY for the Town of Queensbury
Building and Zoning Id 'ctor
, OF QUEENSBURY
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- j APPLICATI i RSEPTIC DISPOSAL PER
MIT
DATE: %svoko,_ 0 - . 3/
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LOCATION OF PROP Y FIR INSTALLATION 4 3 -
Owner' s Name: .�. ��� L. �� erne/eS
Address: 8 ---.
Installer' s Name: Ott ee, &-v Telephone: 7 &2L?'VF
Number of bedrooms (residential only) 7
Total daily flow (compute @ 150 gal per bedroom) ?0-0
Topography: Circle one: 4 Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand) Loam Clay Other /Depth:
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what depth? Feet
Percolation test: Circle one: not required required
Rate.- Min. Per Inch
Domestic water supply: Circle one: Munici Well Other
If domestic water supply is a well :
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench Q feet/Total system length //f2fc) .. feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used if /Depth or Thickness feet
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HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal .
*Alarm system and associated electrical Mork 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: DATE: J 11 /— 7/
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 Co 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 co 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 drywalls
B. Nu system shall be covered before inspection and approval by the
auilding Inspector. Failure to comply with this requirement may
rusult in the uncovering of thd system by the installer and a fine
uf 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 may -
result 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
bu submitted co the Queensbury Building Department before, further
construc c ion.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
kumarks:
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BUILDING and ZONINDEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
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SEPTIC DISPOSAL SYSTEM INSPECTION
NAME S I emei es) 90
LOCATION 24 �j ectiY P
DATE (p / O PERMIT NO. /
SOIL TYPE - eilal- Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, 'total length /3(13
Length of each trench 'yD
Depth of trenches a 51 /
Size of gravel . 1`
SEEPAGE PITS4Number of)
Size- ft. X
Gravel size
PIPING: ;,Size, Type
Bldg. to tank
Jct,'t'
Tank to dist. box � p�C
Dist. box to field/pit `'G leh5S
Openings sealed? igy " ;ENO Partial
LOCATION/SEPARATIONS: . '
Foundation to tank {'`L[ 1`'f t.
Foundation to absorption fd12%.ft.
Absorption to lot line jb ft.
Separation of pits
LOCATION • SYSTEM;ION PROPERTY(c`ircle one)
Front 411011 Left side - Right 'side -
COMMENTS:
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1 �
1 l,\
SYSTEM USE APPROVED'
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Buildin Ins ector
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01/86 and vl
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BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME Sw�� (J-efi .
LOCATION ' 2 ovc n\_4 r\ e SAY P
DATE ( (? / )61 PERMIT NO. qi -4s
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches
Size of gravel
SEEPAGE PITS{Number of)
Size- ft. X ft.
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box
Dist. box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption ft.
Absorption to lot line ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS:
SYSTEM USE APPROVED YES NO
Building Inspector
01/86 and vl
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