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1991-719 CERTIFICATE OF COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date 6 - I. Jt. 9 19 9/ This is to certify that work requested to be done as shown by Permit No. 91®719 has been completed. This structure may be occupied as a Sep$3 Alteration • 19 Barber Avenue LocaCiO `" • Owner ;dal 1 nr .- Brash By Order Town Board TOWN OF QUEENSBURY (77)41. Director of Bldg. do Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY x No. 91-719 WARREN COUNTY, NEW YORK O PERMISSION is hereby granted to Wallace L. Scott F, cri OWNER of property located at 19 Barber Avenue Street, Road or Ave. 'I i 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 N n O et 2. CONTRACTOR or BUILDER'S Name r+ Condon's Septic & Drain Service a 3. CONTRACTOR or BUILDER'S Address fD 4. ARCHITECT'S Name r 5. ARCHITECT'S Address CO 'S Q rD a 6. TYPE of Construction—(Please indicate by X) fD O ( )Wood Frame ( ) Masonry ( ) Steel ( ) fD 7. PLANS and Specifications Septic Alteration to include: No. 1000 gal . Tank with 1 seepage pit 10' x 8' using #3 stone, 2' Thickness as per plot plan specifications and application re 8. Proposed Use Septic Alteration ro e+ $ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 9, 19 93 0 (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 9th D7ff October 19 91 SIGNED BY for the Town of Queensbury Building and Zoning Inspector Iftri j TOWN OF QUEENSBURY �/ APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # �17/' Fee Paid.." Date: /0 F.` 7/ Reviewed gN OF QUE UFi LOCATION OF PROPERTY FOR INSTALLATION: / 9 /2A BE Q AYE OCT a 1991 Owner' s Name: I1.)AII,C, . SCo TT' BLDG. & CODE DEPT. Owner' s Mailing Address: /C? 73/4A V� Installer' s Name: atOd r$ t F'/oir`G 1D 1127 SEA Phone #: 79gr^tJ7_`f2- Number of bedrooms (if residential ) : ?- Total daily flow (residential-compute @ 150 gal . per bedroom) : 3 1 PJ Topography-Circle One: 'Flat Rolling Steep Slope % of Slope Soil Nature-Circle One: Sand Loam Clay Other /Depth: Ground Water-At What Depth? �i: Feet Bedrock or Impervious Material-At What Depth? lU/ Feet Percolation Test-Circle One: of Require Required/Rate Min. Per Inch Domestic Water Supply-Circle One: Municipal IP Other If domestic water supply is a well - Separation: Water supply from any septic absorption /0() feet PROPOSED SYSTEM: Septic Tank /oo e gal . (Minimum size: 1,000 gal . ) Tile Field: Each Trench feet//Total System Length feet Seepage Pit(s) : Number of / / Size each: A 9 ft. x 8 ft. Size of Stone to be used: # / Depth or Thickness 2— 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: c Ety\.eLOy._ DATE: 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 $250.00. C. An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installation, alteration or repair of an approved system, a new proposal must be submitted to the Queensbury Building Department before further construction. Town of Queensbury Building & Code Enforcement Department 531 Bay Road Queensbury NY 12804 Remarks: . _ \ r rY) _Jocun"'al Queeniurcy BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL� SYSTEM INSPECTION NAME .('_.c'q)l , MR i[CLC_Q_i LOCATION O. R--- -`?‘ _)%) / v-e.. DATE /0 / PERMIT NO. I 7/9 SOIL TYPE -(San?)- Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field, total length Length of each trench Depth of trenches Size of gravel , SEEPAGE PITS{Number (5f) Size- ft. X :.'/C ft. Gravel size 7 i PIPING: ! I Size pc Bldg. to tank I ly `) 1/C Tank to dist. box f it') a Dist. box to fi ld/pit Openings sealed? ES NO Partial LOCATION/SEPARATIO •S Foundation to tank . �Q ft. Foundation to abso pt,ion )� ft. Absorption to lot ii jft. Separation of pits ft. LOCATION OF SYST ON P OPERTY(circle one) Front Rear - Le t side - Right side - COMMENTS: _ SYSTEM USE APPROVE YES NO Bui ing Inspe tor 01/86 and vl 1.0M.l-,4C I— • SC i T Corvi)ok.5 -SF,-L'c._ -4 D,RA-r'et, „sea . 9 BAAi CA Ave_ M 743 ®)-- f 3 l .Z gfihi1r AVE: 7r8- 8-s-yZ (1,70 ,1vs3,$)-y tea, 010tis r&fls iF f i_rgo/ r a m n. W tip zp rn o ww w C'!U 0 Ng U. os .6 jonq, p',+ 0 CI Y) i t oo° SF --1"(c." 35 4 NS 4)0LL 19 FA/SER- AUK ' .