1991-779 CE
RTIFICATE OF COMPLIANCE,/`
TOWN OF QUEENSBURY
WARREN (COUNTY, NEW YORK
Date i��to . : , 1i... 19 2
• This is to certify that work requested to be done as shown by Permit No. 91-779
•
has, been completed.
This structure may be occupied as a SepticAlteration
Location 167 Dixon Road
Owner Michael Burns
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
- '
TOWN OF QUEENSBURY "
No. 91-779
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Mike Burns l0i
OWNER of property located at 167 Dixon Road Street, Road or Ave. '-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.
co
1. OWNER'S Address is c
Same
2. CONTRACTOR or BUILDER'S Name
Morning Star
793-2290
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3. CONTRACTOR or BUILDER'S Address
k
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4. ARCHITECT'S Name
IZ
t!7
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
1 —I.
( )Wood Frame ( ) Masonry ( )Steel ( ) 0
7. PLANS and Specifications
Septic alteration to include: 1000 gal tank with 200' of Tile
No. field using 02 stone 12"-14" Thickness as per plot plan
specifications
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT.FEE PAID —THIS PERMIT EXPIRES November 6, 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 Queensb7thi 6th ay of November 19 91
SIGNED BY %�/, � for the Town of Queensbury
Building and Zoning Inspector
TOWN OF QUEENSBURY r^S;
�� APPLICATIOFI FOR SEPTIC SPOSAL PERMIT
4. -
DATE: /G1t. . ti 9 ;: `•,
� � •
LOCATION OF PROPERTY FOR INSTALLATION /6? An 6 V ,, 91
Owner's Name: '2,„e,
B J LD & cUIE DEPT.
Address:
Installer' s Name: /2pez.......,)„, �� Telephone: ; 2 '2_-2c
Number of bedrooms (residential only) 3
Total daily flow (compute @ 150 gal per bedroom)
Topography: Circle one: (gat Rolling Steep Slope % of Slope
Soil Nature: Circle one: 110P Loam Clay Other /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: l Well Other
If domestic water supply is a• well :
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank /No, gal . . '(m'inimum size: 1,000 gal )
TILE FIELD: Each Trench so feet/Total system length -zDa feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used #. 2 /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 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.
SIGNATURE OF RESPONSIBLE PERSO n.44..•.k DATE: If — 9i
•
•
Septic Syste■ 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,
• rile fields anal/or drywalls
B. Na system shall be covered before inspection and approval by the
luilding Inspuctor. Failure to comply with this requirement may
result in the uncovering of the system by the installer and a fine
ut up to $250.00.
C. An approved copy of the plot plan .shall be available on the construction
site. Failure co produce said plot plan at time of inspection may
result in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installa •
—
tion, 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 and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
k.ntarks:
!(.:„.I :4/..,4(,)Ri.iti_h„:"i 1"i ,tt:9i l•i•A!;.tY,11i:kti, }. 0h ,-:11 M 4i-jt, k4)tf,�11i h-it(:",A.-11i-)II[:9(.M." •:.?APf,?h :".slIi;:fi Al 01-�•i;Ai t).:•i, •i •_,ti: ,,.Al:,,,h • • i.,, e•,A�
41�3459 7
THE NEW YORK BOARD OF FIRE UNDERWRITERS I`1\. L'
1: BUREAU OF ELECTRICITY
I- 41 STATE STREET,ALBANY,NEW YORK 12207
if' Date JUNE 4,1994 Application No.on file 13393794/941 A 097518
THIS CERTIFIES THAT :::{1
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of •;!
HIKE BURS. :I.67 DIXON RD. , Qu u Ns BURY. N.Y. 96- 7 7. , '`a
in the following location•. 0 Basement {�13`1' 9 i _ 7 9 4,
,» ❑ 1st Fl. ❑ 2nd Fl. Section Block Lot
?Urdu, 21,:E.99
was examined on and found to be in compliance with the National Electrical Code. `'i
: ':
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
�. OUTLETS RECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K.W. MAT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
-c
►'. 'i
t
DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS Ha UNIT HEATERS MULTI-OUTLET DIMMERS ,'
AMT. K.W. OIL H.P. GAS H.P. MAT. NO. A.W.G. AMT.' AMP. _ AMT. AMPS. TRANS.• AMT. H.P. NO. FEET AMT. WATTS ;;
cil
:,F...,
1.
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►; SERVICE DISCONNECT NO.OF S E R V I C E
, MAT. AMP. TYPE EQUIP. 1,e'2W 1 F 3W 3,0'3W 3 Jil 1W No.OARCirCOND. OF CC.COND.. NO.OF HI-LEG Of'H•LEG NO.OF NEUTRALS OF NEUTRAL ,
'i.I 20e CO 1. X 1 4/0 1 2/0
v:
. OTHER APPARATUS:
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iiP • 1300 11[1RTt 1P r ,•t-
91 14 t4NSS RD. _ . crT'`.7e:`
•
BRANCH MANAGER
GLENS PALLS ii' . NY 12801 ;
' 239
6 Per
This certificate must not be altered in any manner;return to the office of the Board if incorrect. Inspectors may be identified by their credentials. •'
Li-ai- o ® 5101151051E Boa ® 5112ESE War MEI oeol7Mill fliESE1 oa ®
COPY FOR BUILDING DEPARTMENT.THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
Jown o/ Q , 4/22
• BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME aduk 4
LOCATION 16i Pcc J
DATE 00 PERMIT NO. 9/-
SOIL TYPE - San Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
!;s
Absorption field, total length )-f'h
Length of each trench l' G,
Depth of trenches
Size of gravel t o .'
SEEPAGE PITS{Number of) _ ;
Size- ft. X
Gravel size , �,
PIPING: ,Size Type
Bldg.. to tank ` / re/o,
Tank to dist. box y" i"
Dist. box to field/pit' v /J (� V
�,r
Openings sealed? YES NO Partial
in
LOCATION/SEPARATIONSilz
Foundation to tank �l' ; /b ft.
Foundation to absorptiron 75,-6 ft.
Absorption to lot;linef2) ft.
Separation of pits 6- .ft.
LOCATION OF SYSTEM ONiPROPERTY(circle one)
o�°F - Rear - Left side - Right side -
COMMENTS:
SYSTEM USE APPROVED (Eb) NO
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Bud/ding Inspe6tor
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