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CERTIFICATE OF CO]MPLIA.NCE
TOWN OF QUEENSSURY
WARREN COUNTY, NEW YORK
Date -%% f --- 19
�~ 1 92^250
This is to certify that work requested to be done as shown by Permit Nov
has been completed.
This structure may be occupied as a —. Se t�i r,Al ter ti on
Location _, Gurney Dane
Owner Jose h Sherry Wi 11 i ams
By Order Town Board
PrOWN OF QUEEN5SURY
Director of Bldg, do Code Enforcement
BUILDING PERMIT
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TOWN OF +QUEENSBURY No 42-250
WARREN COUNTY, NEW YORK o
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PERMISSION is hereby granted to Joe Yi l 1 1 ans M
OWNER of property located at _ Gurney Lane Street, Road or Ave_
in the Town of Queensbury, To Construct or place a ,� $antic A ration
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_
JW
t, OWNER'S Address is N
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Sam
2. CONTRACTOR or BUILDER'S Name
SAnitary Sewer
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
S. ARCHITECT'S Address
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6, TYPE of Construction — (Please indicate by Xi A
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( ) Wood Frame ( f Masonry ( } Steel I } '+
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7. PLANS and Specifications
Septic Alteration to include : .
No. 1000 Gal . tank with 125 ' of the field using #2 stone , 1 ' thickness
as per plot plan specifications and application
B_ Proposed use
Septic Alteration
$ 25_00 PERMIT FEE PAID — THIS PERMIT EKPiRES May 20a 19 94
(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 D of .+ Ma]r 19 42
SIGNED BY for the Town of Queensbury
Build! and Zoning ct
TOWN OF QUEENSBURY �
{ C� APPLICATIMI FOR SEPTIC DISPOSAL PERMIT
DATE : - F a� I r- I f QWN OF OUEERECEiVED
(n .
LOCATION OF PROPERTY FOR INSTALLATION
Owner ' s Name : . fi' c) -c- .e r36c,, 1
Address : �, rL fL BLDG. & +GLIDE DEPT.
Installer ' s Name : ,q ,., ; ., ,N � r c - Telephone : 7 9.2,
Number of 'bedrooms ( residential only ) 2-�
Total daily flow ( compute @ 150 gal per bedroom ) J L
Topography : Circle one : Flat Rolling Steep Slope % of Slope
Soil Nature : Circle one : nd Loam Clay Other /Depth :
Ground Water : At what depth? Feet
Bedrock or Impervious Material : At what depth ? Feet
Percolation test : Circle one : nat require required
Rate - 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 ' 3 feet .
PROPOSED SYSTEM : Septic Tank 7 _gal . ( minimum size : 1 ,000 gal )
TILE FIELD : Each Trenches feet/Total system length J feet
SEEPAGE PIT( S ) 0 Number of / Size each feet
by feet 7
Size of stone to be used N /Depth or Thickness / feet
�+�,►�nirw,Hr,r,r,t,►,t,►.r,r w.r+►tit sr wye,r,e r.
HOLDING TANK SYSTEM IF REQUIRED
NO , of Tanks Size of Each Gal .
*Alarm systew 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 ,
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SIGNATURE OF RESPONSIBLE PERSON : I -� DATE ; r �
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1
Ses� atns�eccione :
A . All applicacia" for septic syates installation , olceracion or repair ,
as required by the Town of Queensbury Sanitary Sswags Ordlnancea @hall
be aubalccid to the Huilding Deparcnont at Least 24 hour * before scars
of construction and *hall include a plot plan showing :
1 . ) the proposed location of Cho systo s
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 all tanks . distribution boxese
tile, fields an#t / or drywells
B . Nu system shall be cover*d before inspeccton and approval by this
Uuilding Inspuctor . failure to comply with this requirement may
rvaiult in the uncovering of tha system by the installer and a fine
oaf up cc $ 2500000
C . An approved copy of the plot plan shall be available on the construction
site . Failure cc produce, said plot plan at ties of inspoccion m y
rusult in an inmediace work stoppage .
D . Should unforeseen problems during construction prevenc proper tttstalla—
cion , alcsracton or rup.Air of an approved system. a new proposal maesc
bu submitcad to the Quawnsbury Building Departwont before further
c: otti * truccion .
Towle of Quaensbury
BUILDING and CODES DEPARTMEW
Bay and Haviland Roads
Queensbury . Now York 12804
kun#;lr1:s
Journ a� �ueen �l6ure� ,n�'"
BUILDING and ZONING DEPARTMENT ra
Bay and Haviland Road, R. D. 1 Box 98 /
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM I'yNSrPECTION
NAmE
LOCATION /
SATE . / PERMIT NO ._.. r+ �C� G'
SOIL TYPE San Loa - clay -
Percolation Required? Yns 4: OO"�"
Percolation rate - Min/Inch
TYPE of SYSTEM: a
Absorption field ; total lengr i �v
Length of each tronch t-F
Depth of trenche s'�
Size of gravel x+'
SEEPAGE PITS4Numbbee4_r of)
Size- ft. X ft.
Gravel size
PIPING : ze Type
Bldgm to tank �F�qG rj JvG
Tank to diet. box 51 cam"
Dist. box to fieldf zi: jrMC
Openings sealed4 NO Partial
LOCATION/SEPARATI S :
Foundation to t ft. OP K--'
Foundation to ab orptiox ft � "
Absorption to 1 line ft 2Ld
Separation of p is i {eft.
LOCATION OF SY EM ON PRO ERTY (cixcle one )
Front - ea Left side Right sx e -
COMbIENTS : �''�
�--C.1.1 2 ry f fP47 �__��+�fi' IIJJ f3 lr l f� A/
SYSTEM USE APPROVED Y NO
Building Spector
01/66 and vl
MAY 18 1992
� . BoD - & CODE DEPT.
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REVIEWED BY