1991-790 t -='CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date ` 7ni/(2Z kt.3 (19
This is to certify-that wor requested to be done as shown by Permit No. 91 7ZO
has been completed.
This structure may be occupied as a Septic Alteration
Location ; of i s Rd North
Owner Peter ary Ann Puri ce11 i
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT .�
TOWN OF QUEENSBURY
No. 91-790
WARREN COUNTY, NEW YORK 0
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PERMISSION is hereby granted to Peter & Mary Ann Puricelli
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OWNER of property located at Knoll s Rd North 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 -fl
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is CD
Same
CD
2. CONTRACTOR or BUILDER'S Name '*
(D
Hometown Sewer
mo
623-2453
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
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( )Wood Frame ( ) Masonry ( ) Steel ( )
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7. PLANS and Specifications CD
No. Septic alteration to include: 250' of Tile field using 02 stone
2' Thickness as per plot plan specifications and application
8. Proposed Use e+
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Septic Alteration
•
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES November 8, 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_____$th D y o: November 1991
SIGNED BY �/'`:� i i for the Town of Queensbury
Bui del irfg nd Zoni ' I nspe or
— 3 �' /lS�„ ;'rya� r..r n)tr.-r.,rzE yC'el,:,
♦ .1 TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMTT\/ ( 199 'ermit #
Fee Paid -
Tak / (. G LL/ f _DG. & CODE DEPT.
Date: ////,--/q/ Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: /-/tea//g /5.cejogon77,7
Owner' s Name: ANNaintia, ,�c e.7 : ' (fin Ter, ' "Aa
Owner' s Mailing Address: 0.47,4 „teeys�u��
- Instal ler'.s Name: /-7re e. . $ems.ef, -- ---- Phone #: G,z3,,,e /x
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom) : 4/570
Topography-Circle One: Fla Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay" Other /Depth:
Ground Water-At What Depth? C4!_, yr, . Feet
Bedrock or Impervious Material-At What Depth? � � Feet
Percolation Test-Circle One: Not Required Required/Rate 57 Min. Per Inch
Domestic Water Supply-Circle One: Municipal Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption //d feet
PROPOSED SYSTEM: Septic Tank gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench 6'5 feet//Total System Length 2 5 O feet
Seepage Pit(s) : Number of ./ Size-each: - ft. x ft.
Size of Stone to be used: # r / Depth or Thickness ,g 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: - /.0,46, DATE: /%/4249/
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)--l-ocat-ton --and -di-stance to—s t'ucture-s— - =
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:
m --__--__----
'2d iz nz /-�-0-I- . •
Jown of Q , '-� a
,BUILDING and ZONING DEPARTMENT, ' V
Bay and_Haviland Road, R.D. 1 Box 98
. •Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM/INSPECTION
NAME &6-1 1u� ,l`--n n 6thafik
LOCATION et/4_11f,, Rat fiet-e.A4
DATE& i' if, PERMIT NO. ' C/7 -/V6
• SOIL TYPE - Sand - Loam Am_
Percolation Test Required? - NO/`?
Percolation rate - Min/Inch c --tav,�/yj,��.t
TYPE of SYSTEM: '. I 7-- Gax+R�c !�
Absorption field, total lengthof
:-a
Length of each trench' ,.. g /
Depth of trenches ' fi,,,i , /
.Size of gravel { 4L I _
SEEPAGE PITS{Number of) ' y�%
Size- /ft. X , ft.
Gravel size , ., .(f
PIPING: Size Type
Bldg. to tank iii'4 Pe-
Tank to dist. box a �, <<
�
Dist. box to field/p t, x' i K
Openings sealed? j� ;+NO _ Partial
(
LOCATION/SEPARATIONS:/
Foundation to tank cx,s ft.
Foundation to absor tion 5 ft.
Absorption to lot line0 ft.
Separation of pits . ft.
LOCATION YSTEMON PROPERTY_(circle one)
Fron - Rear Left side - Right side -
COMME S: 1.�
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SYSTEM USE APPROVED .ii NO
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Bui 'sing Inspector
01/86 and vl ••
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t OWN OF QUEENSEU
RECEIVED
N i
NOV 7 1991
6 P".DG. & CODE DEPT'.
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