1991-668 cr41
CERTIFICATE OF .;COMPLIANCE
TOWN OF QUEENSE,URY
WARREN COUNTY, NEW YORK
Date AV Pf/.�/. d,/19 lL
This is to certify that work requested to be done as shown by Permit No. 91-668
has been completed.
This structure may be occupied as a
Septic Alteration
Location 57 Country Colony Drive
Owner Claude White
By Order Town Board
TOWN OF QUEENSBURY
'r/
Director of Bldg. &Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 91-668 c
WARREN COUNTY, NEW YORK •,
41.
PERMISSION is hereby granted to Claude White
OWNER of property located at 57 Country Colony Drive 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 :C
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OWNER'S Address is
Same `'
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2. CONTRACTOR or BUILDER'S Name
Ron Dufour
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name 0
4.4
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
Septic Alteration to include:
No. 1000 gal tank with 2 seepage pits each 8' x 8' with #3 Stone
as per plot plan specifications and appliration rt
8. Proposed Use
Septic alteration
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES September 20, 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 20th Day of September 19 91
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SIGNED BY C/ GU for the Town of Queensbury
Building and Zoning Inspe or
utiVN OF QUEENS bL;,.
RECEWED
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j TOWN OF QUEENSBURY /- �/
APPLICATION FOR SEPTIC DISPOSAL PE g 18 1991 Permit # qj(p�QD
Fee Paid
r'LDG, & CODE DEPT.
Date: 9//f/9/ Reviewed
LOCATION OF PROPERTY FOR INSTALLATION: 5-'7 (7Dy/,j.€fL CbLDN (.1 i)'e
Owner' s Name: L'.��/7LO,06 Gc)///7- I
Owner' s Mailing Address: 5-7 douV77QL, [roLNc., L6
Installer' s Name: -TM ,�UFOU f2 J Phone #: 79g-/‘(/it
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom) : 27
Topography-Circle One: ispoRolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other(WE L_ /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: Municipal Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank S::CC, gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s): Number of / Size _each: _k9 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.
SIGNATURE OF RESPONSIBLE PERSON: aL4e :_7 .%Z DATE: 4/2,7ZeZ__
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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BUILDING and ZONING DEPARTMENTM/
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME �:4/�l./,-/j h)/'/i l
LOCATION 61G(7w 'uj �U[d%ill ��
DATE /9 PERMIT N/JO.
SOIL TYPE ler - 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 1
Size of gravel_
SEEPAGE PITS{Nuinbe of)
,Size- ft. X ft.
Gravel size . -7 \4 ' J'
PIPING: \\Si J / T pe
VC_
to tank `1 ;,
Tank to dist. box ''/,
Dist. box to field/pit
Openings sealed? YES VNO Partial
LOCATION/SEPARATIONS:
Foundation to tank 1 \ t.
' Foundation to absorption W> ft.
. Absorption to lot line/ j'6-J ft.
Separation 'of pits / e ft.
LOCATION OF SYSTEM ONIPROP 1 one)
Front ear - Left side Right side
COMMENTS:
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SYSTEM USE APPROVED 40 NO
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