1991-512 ,
s:
CERTIFICATE OF COMPLIANCE t
TOWN OF QUEENSBURY -)
•
WARREN COUNTY, NEW YORK
Date July 26..19•a
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This is to certify that work requested to be done as shown by Permit No. 91-512
has been completed.
This structure may be occupied as a Septic Alteration
Location East Surmyside
Owner Edna Duprey
By Order Town Board
TOWN OF QUEENSBURY
7
Director of Bldg. 6: Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-512
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Edna Duprey
1
OWNER of property located at East Sunnyside 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
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
Same
2. CONTRACTOR or BUILDER'S Name
Fortino Excavating
623-2059
3. CONTRACTOR or BUILDER'S Address
N
4. ARCHITECT'S Name .�
e+
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No.Septic Alteration to include: 1,000 Gal Septic Tank with 200' of Tile
field as per plot plan specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES July 17, 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 17th Day f July 19 91
SIGNED BY `� /-�
for the Town of Queensbury
Building and Zoiii Inspector
Aft
Ns- j TOWN OF QUEENS: 'Y (1 � 1�
APPLICATION FOR SEPTIC DISPOSA P '. . Permit #
Fee Paid 3
Date: 5)1 5/9 ) / Reviewed By
LOCATION 0 PROPERTY FOR INSTALLATION: e�c q- � �, s, p
Owner' s Name: , C� n a
Owner' s Mailing Address:
Installer' s Name: FO M0 F-pDt,,,4276,,e Phone #: lF 6,2I O
Number of bedrooms (if residential ): 3
Total daily flow (residential-compute @ 150 gal . per bedroom) : y 5 6
Topography-Circle One: 's. J Rolling Steep Slope % of Slope
TOWN of GIU�t�►va .y :
Soil Nature-Circle One: a d Loam Clay Other =p ; O \F a
j .
Ground Water-At What Depth? Feet '
Bedrock or Impervious Material-At What Depth? FeetJUL 1 mVi
Percolation Test-Circle One: Not Requi red Required/Rate MiR 1t rINfncBhOOu" "1:'
Domestic Water Supply-Circle One: Municipal Well Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption / 00 feet
PROPOSED SYSTEM: Septic Tank J/ QUO gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench SOU feet//Total System Length G2O C' 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 rever-se 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: 0,,4- DATE: 7 -/J
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 cop of the plot plan shall be available on the construction
site. Fa'ilurto produce said plot plan at time of inspection may result
i,n .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:
i / mat
s , _Jocun o f Queenibury
BU'ILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DIS'OSAL SYSTEM INSPECTION
NAME (A961} ./►&i t L(
LOCATION da/2(4't4' _ate)
DATE 7/ 7/ q/ PERMIT NO. �/ f
SOIL TYPE - and Loa - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch.
TYPE of SYSTEM:
Absorption field, total length
Length of each trench z/4
Depth of trenche '
Size of gravel'_ L� _
SEEPAGE PITS-fNumber of)
Size- ft. X ft.
Gravel size .
PIPING: ` ize Type
Bldg. to tank < A< ,
Tank to dist. box q 'I /
Dist. box to field/pit `41
Openings sealed? YES /NO P rtial
LOCATION/SEPARATIONS:
Foundation to tank / 2ft.
• Foundation to absorption 5� ft.
. Absorption to lot line ft.
Separation of pits I ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left' side - Right side -
COMMENTS:
SYSTEM USE APPROVE YES NO
•
Bui g Inspect9'r
01/86 and vl
•
_own of Quenihurcy
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
•
•
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME ;c Q(-2 L'(
LOCATIONS(I)4,- f A5 1 •
DATE 'I/ '/�d PERMIT NO. "!( - St �-
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 to •
Tank to distbox ,-
Dist. box to flkeld/p'it
Openings sealed YES . NO Partial
LOCATION/SEPARATIaNS:
Foundation to tan @'\ ft.
Foundation to abs'rp,\ion ft.
Absorption to lot line ft.
Separation of pit? X ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Ldit side- Right side -
COMMENTS:
Co 0-1-2A- VC)C__ lq-,kv5-1-AAST6-11)•
VS T-J2,Lre:Tt L'IJ G.,v/V t'I.t�'�4-S'r .�1
�if� 3PG-gl /H marks 7-- mg,� -.
Cc)l/it4c—j 0 v -RD Luit S d�
- A-Pice.
SYSTEM USE .APPROVED' YES) b-)
• Oi i(/ I
B ildi=ng inspector
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01/86 and vl
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. JUL 15 1991
_
BUILDING & CODE DEPT.
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