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1991-824 CERTIFICATE OF COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date November 2119 91 This is to certify that work requested to be done as shown by Permit No. q 1—R 7 a. has been completed. This structure may be occupied as a sewage alteration Bay and Sunnyside Road Location Frank Zverblus Owner By Order Town Board TOWN OF QUEENSBURY V Director of Bldg. & Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY No. 91-824 a WARREN COUNTY, NEW YORK o PERMISSION is hereby granted to Frank bl-us ,Z veY` Z o us OWNER of property located at Bay & Sunnyside Rd 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 Queensbury Sewer Jay Sweet_ 792-364R 3. CONTRACTOR or BUILDER'S Address 4. ARCHITECT'S Name • 5. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) ( )Wood Frame ( I Masonry ( )Steel ( 7. PLANS and Specifications Septic alteration to include: No• 1000 gal tank with 200' of tile field using #2 stone 10" Thickness as per plot plan specifications and application 8. Proposed Use Septic Alteration $ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES November 21, 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 24. Day of November 19 91 SIGNED BY for the Town of Queensbury Building and Zoning Inspecto/ /,�. B OWN OF QUEENSBL, ` � TOWN OF QUEENSBURY REC%-°VED APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # NOV 2 0 199ee Paid Date: / if- 2_ .2c- .77 tLDG. & CODppd By LOCATION OF PROPERTY FOR INSTA'LATION: Ce-1 S't(. h y1 ..S'( cic led 0 Owner' s Name: - C� � � ic uS ye✓b US Owner's Mailing Address: a ee.4.,s Installer's Name: 6? ('�4✓S d>t��r` Taij-x-V Phone #: Number of bedrooms (if residential ): l ' I Total daily flow (residential-compute @ 150 gal . per bedroom): o- Topography-Circle One:. Fla Rolling Steep Slope % of Slope Soil Nature-Circle One: "a • Loam Clay Other /Depth: Ground Water-At What Depth? Feet Bedrock or Impervious Material-At What Depth? Feet Percolation Test-Circle One: Not Re uy' a Required/Rate Min. Per Inch Domestic Water Supply-Circle One: Municipal el Other If domestic water supply is a well - Separation: Water supply from any septic absorption (-7.) feet new_ l©oS ' PROPOSED SYSTEM: Septic Tank ,_( 5 h,'al . (Minimum size: 1,000 gal . ) Tile Field: Each Trench ; feet//Total System Length 5-6r-J feet Seepage Pit(s): Number of / Size each: ft. x ft. Size of Stone. to be used: # ,Z. / Depth or Thickness /0 „ feet ************** HOLDING TANK SYSTEM IF REQUIREp 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. q SIGNATURE OF RESPONSIBLE PERSON: 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 S 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 • S , • Building .& • Code Enforcement Department 531' Bay Road Queensbury NY 12804 Remarks: • �ocun o� Queen urty- - BUILDING and ZONING DEPARTMENT. Bay and Haviland Road, R.D. 1 Box 98. . •Queensbury, New York 12801 SEPTIC DISPOSAL-SYSTEM INSPECTION NAME ,a,b ..f4 LOCATION Za_.y otA Seim,re,,. e y7 // j aLG DATE �/2// 9/ PERMIT NO. / 9/(-W( SOIL TYPE - an Loam .- Clay - ' • Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field, total length O20-(E) Length of each trench' �,� Depth of trenches ' 02 f - ' Size of graveIz20,2 _ SEEPAGE PITS{Number of) ' Size- ft. X ft. Gravel size . PIPING: Size Type Bldg. to tank 5( Tank to dist. box ' 5( Dist.- box to field/pit c� 1{ Openings sealed? a' NO Partial LOCATION/SEPARATINS: Foundation to tank /5 ft. Foundation to absorpti , ft. .Absorption to lot fine j25 So ft. Separation of pits — ft. LOCATION OF SYSTEM ON, PROPERTY(circle one) Front - Left, side - Right side - COMMENTS: / f tar n • • SYSTEM USE APPROVED NO • • Bpi ing Inspector 01/86 and vl • 9• 3o' • Jown of Queenihur,e • BUILDING-and ZONING DEPARTMENT . Bay and Haviland Road, R.D. 1 Box 98 •Queensbury, New.York'12801 • SEPTIC' DISPOSAL SYSTEM INSPECTION NAME . swe gZ. . • LOCATION 44�. /9 y- c3Unr7.5�( . DATE ////9/ PERMIT NO. I/k02 (• 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 f . ,/ Gravel size PIPING: ,Size Type Bldg. to tank l Tank to dist. box ' { ii, Dist. box to field/pg • Openings sealed? YES ' NO Partial LOCATION/SEPARATIONS] Foundation to t- k ft. Foundation to .bsorption ft. Absorption to lot line ft. Separation if pits ft. LOCATION o SYSTEM ON PROPERTY(circl-e'one) Front - 'ear - Left side -1Right side - COMMEN i : �_�. • 02,\\7, , . . • SYSTEM USE APPROVED YES NO . ' Building .Inspector _ • 01/86 and vl . e1cr)S 1411/ I OI c ssooil � a 0o/ \et) os F