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1991-454 (,CERTIFICATE OF COMPLIANCE - TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date UL A /0 • 19 41/ This is to certify that work requested to be done as shown by Permit No. 91'454 has been completed. This structure may be occupied as a Septic Alteration Location Stannysidp Road Owner Elva Winermott By Order Town Board //TOWN OF QUEENSBURY Director:of Bldg. do Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY No. 91-454 T' WARREN COUNTY, NEW YORK c cri PERMISSION is hereby granted to Elva McDermott OWNER of property located at Sunnyside Rd Street, Road or Ave. F-+ 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 a Same 3 CD a 2. CONTRACTOR or BUILDER'S Name e+ Walter Stevenson Vf 3. CONTRACTOR or BUILDER'S Address CD • a 4. ARCHITECT'S Name ' N CD .� r+ 5. ARCHITECT'S Address rh CD 6. TYPE of Construction— (Please indicate by X) '++. 0 ( I Wood Frame ( ) Masonry ( )Steel ( ) 7. PLANS and Specifications Septic Alteration to include: No. 1000 gal. Septic tank with 250' of tile field using #2 stone, 1' Thickness as per plot plan specifications and application 8. Proposed Use Septic Alteration $ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 27, 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 this 7th Da of / June 19 91 �// SIGNED BY ////.��� /��� for the Town of Queensbury Bui ding and Zoning Spector TOWN OF QUEENS3LlF14 `� �. RECEIVES Njiral TOWN OF QUEENSBURY APPLICATION FOR SEPTIC DISPOSJNE2V 1991 Permit # Fee Paidpr DICA3. & C DE CEn. Date: Y7 / Reviewed By LOCATI N OF PROPERTY FOR INSTALLATION: G yl � Owner' s Name: /771 �/ /1C ,O/1 p 7 Owner' s Mailing Address: .5'0/car'S /fie i9n/, Installer' s Name: 1/6//40- /.,, 19/r SP r/eds OW// Phone #: 7cri` 27/ Number of bedrooms (if residential ): Total daily flow (residential-compute @ 150 gal . per bedroom) : Topography-Circle One: Rolling Steep Slope % of Slope Soil Nature-Circle One: Sand Loam Clay Other /Depth: Ground Water-At What Depth? ,O e e /41, Feet Bedrock or Impervious Material-At What Depth? Feet Percolation Test-Circle One: Not Required Required/Rate / Mina Per Inch Domestic Water Supply-Circle One: Municipal alpOther If domestic water supply is a well - — Separation: Water supply from any septic absorption /OC) feet PROPOSED SYSTEM: Septic Tank /OOc) gal . (Minimum size: 1,000 gal . ) Tile Field: Each Trench a-0 feet//Total System Length r 3 J feet Seepage Pit(s) : Number of / Size each: ft. x ft. Size of Stone to be used: # / 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. **************** 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. �� rT / SIGNATURE OF RESPONSIBLE PERSON: ,4 a l?r DATE: U G 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: anti -4-//i)�. afore 3 P117 • ----y .Own o/ ueen3ur, BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 • SEPTIC DISPOSAL SYSTEM INSPECTION NAME ��� lJcnrc\S\ V \'sm_ ' "l LOCATION comv\i6.,-"(0 (�--- C1), DATE 1 / / PERMIT NO. 9' J ' i �LJ SOIL TYPE -Et—le. Loam - Clay - _ Percolation Test Required? YES = NO) Percolation rate - Min/Inch TYPE of SYSTEM: 1 Absorption field total length 12 > CJ Length of each t ench () Depth of trenche " �..„4 r1_; Size of gravel '1112--z, _ SEEPAGE P ITS{Num � L /'�er •f-) 4 Size- _--- �,X ft. (/ �/ Gravel size �- i PIPING: `� Siz Type Bldg. to tank At rti Tank to dist. box / 1; J%'v/L---. Dist. box to field/p-i-t--F, 4 j v Openings sealed? E � NO Partial LOCATION/SEPARATION k Foundation to tank \ ft. Foundation to abs rption ft. Ole— Absorption to to link ft. Separation of pi s . ft. LOCATION-OF-SYS1TEM ON PROPERTY(circle one) Front - Rear Left site - Right side - COMMENTS: \ . -- SYSTEM USE APPROVED YES, NO \ .l� Y Building inspector 01/86 and vl TOWN n OF CIL/ .ENSBUR•a RECEIVED JUN 2 61991 i b G` K BLDG. & CODE DEPT. o alfr g Fr_ - i---.6 ct, , e___ 1: /5 • �© ic 7,-Log TOWN OFAY o BU F-. _- - .C: T. 'ES DEPT. . .� REVIEWED 6'f �, / __— DATE _ _ . _ /J4/J 17 10 /1/ d . SJ n i \l s A t