1991-860 CR.
L •�o-�T
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date December 27, 19 91
3CR
This is to certify that work requested to be done as shown by Permit No. 91460
:... has been completed.
This structure m" "'
may be occupied as a Septic Alteration
Location ��Ohl� � Avenue
Owner Pauline Palmer/Labarge
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
•
BUILDING PERMIT -�
TOWN OF QUEENSBURY
No. 91-860 -0
WARREN COUNTY, NEW YORK c
PERMISSION is hereby granted to Pauline Palmer/I aharg
OWNER of property located at
p p ty Box ]94 Michigan Avenue Street, Road or Ave. it
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.
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1. OWNER'S Address is ..
Same co
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2. CONTRACTOR or BUILDER'S Name
Louis Smith
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
to
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6. TYPE of Construction—(Please indicate by X)
C)
( )Wood Frame ( ) Masonry ( I Steel ( )
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7. PLANS and Specifications a
No.Septic Alteration to include: 2 seepage pits each 6' x 8' using #3
stone, 2' Thickness as per plot plan specifications and application
8. Proposed Use
Septic Alteration
$ ?5 00 PERMIT FEE PAID —THIS PERMIT EXPIRES December 18, 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 lath D of , ,, DPrPmhPr 19 91
SIGNED BY / G for the Town of Queensbury
Building and Zoningl, spector
A) 6 2
At d -s
� � TOWN OF QUEENSBURY /
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # 1 4400
Fee Paid - - O O
Date: 7 Reviewed /444/
LOCATION OF PR PERTY FOR INSTALLATION: h20/yf7 ,,,_„,,,,7
Owner' s Name: eiti793 — 55/(
Owner' s Mailing Address:
Installer' s Name: ‘7Phone #:
Number of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 gal . per bedroom): `--=" 13 1991
Topography-Circle One: Fl a Rolling Steep Slope % of Slope_ n. 0 2. & CODE DEPT.
Soil Nature-Circle One: San Loam Clay Other /Depth:
Ground Water-At What Depth? /d 7" Feet
Bedrock or Impervious Material-At What Depth? ,J(/r Feet
Percolation Test-Circle One: Not Required Required/Rate jj/A Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trenchfeet/-/Total System Length Lfeet
Seepage Pit(s) : Number of / Size each: 4, ft. x ft.
Size of Stone to be used: # i / Depth or Thickness p7 _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 Queens -. ry Sanitary Sewage Disposal
Ordinance.
�5
SIGNATURE OF RESPONSIBLE PERSON: /1 ��L , DATE: / /, ,4-
•
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:
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
531 BAY ROAD
QUEENSBURY, NEW YORK 12804
TELEPHONE (518) 745-4447 '
BUILDING INSPECTOR'S REPORT 901N
REQU FOR INSPECTIO I
RECEIVED c � {
NAME ' 4t ANSA 0
LOCATION_ i( Xi �
DATE� - `l J PERMIT # C / -/�b
TYPE OF-STRUCTURE G3C_Vc .,
I
RE-cHECK r � tjt-GC APPROVED
_ -- N/A YES NO
FOOTINGS/PIERS
MONOLITHIC POUR FORM
REINFORCEMENT IN PLACE
THE CONTRACTOR IS RESPONSIBLE
FOR PROVIDING PROTECTION FROM
FREEZING FOR 48 HOURS FOLLOWING
THE PLACEMENT OF THE CONCRETE.
MATERIALS FOR THIS PURPOSE ON SITE
FOUNDATION/WALL POUR
REINFORCEMENT IN PLACE
FOUNDATION/DAMPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
PLUMBING VENT/VENTS IN PLACE
PLUMBING UNDER SLAB
FRAMING: ti
JACK STUDS/HEADERS �, I
BRACING/BRIDGING 'e I
JOIST HANGERS \ /
JACK POSTS/MAIN BEAM \
HEATING ROUGH-IN i
INSULATION:
FOUNDATION WALLS INTERIOR R-j
FOUNDATION WALLS EXTERIOR R. 1
FLOORS R- 1
WALLS .R- \
CEILING 4R-
DUCT WORK OR PIPING IN UNHEATED
SPACES, d`
REMARKS: '
) c[-fo-efL 1-eb-I PA'm•
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cJ� (!), 1/ i 11
ARRIVE (.= 4/0
DEPART /%
IN' EC R
....,, \\,,b, ._ . pn? iitpriii
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' own of Queeni ur, -
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION. '
NAME )la c)
1 Yl \
LOCAT I CO \L1)1\ c, I\r\,,N`-e- Gi1` 1 -
DATE jg /c PERMIT NO. q/--g(00
SOIL TYPE L 'San - Loam - Clay -
Percolation est Required? YES - NO .
Percolation rate -- Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench J
Depth of trenches
Size of gravel t 4
SEEPAGE PITS{Number xf)
Size- ' (9 ft. X t . a‘ S
Gravel size , ._ ,
PIPING: ' Size Type
Bldg. to tank CIA-V. -
Tank to dist. bo . 1A-
Dist. box to fi d .�'. y .L \.‘
Openings seal ? /YES' NO - Partial
LOCATION/SEPARATIONS: ) L •
Foundation 'to tank y‘'5C1 ft.
Foundation to absorption '_90 ft.
Absorption to lot line ;5 ft.
Separation of pits • 9j ft.
LOCATION• OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side- Right side -
COMMENTS:
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1 C:i - .k
v‘ 14A, Q. m r 0.6-p.„,,,, i
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SYSTEM USE APPROVED Y S ,
Buil Spector _
01/86 and vl -
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ocoui4 c)initli excavating -
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,- gaingiE BEaak _Roacl
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ottvravitte, SV.ry. 12860
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. (518) 494-3890
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