91-237 �aa
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.� CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 6 ,,/ .2 y 19 L
This is to certify that work requested to be done as shown by Permit No. 91-237
has been completed.
This structure may be occupied as a septic alteration
578 Bay Road
Location
EDWARD ALLEN
Owner
By Order Town Board
TOWN OF QUEENSBURY
% 1j ' `7S/ll /fin
Director of Bldg. do Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No. 91-237 '
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Edward Allen
OWNER of property located at 578 Bay Road 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
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2. CONTRACTOR or BUILDER'S Name m
Walter Grahame
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3. CONTRACTOR or BUILDER'S Address -S
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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 ( ) Cu
7. PLANS and Specifications
No. Septic alteration including 200 feet of tile field as per plot plan,
specifications and application.
8. Proposed Use
Septic system
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$ 25.00 PERMIT FEE PAID—THIS PERMIT EXPIRES April 25 93 19
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(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.) —1
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Dated at the Town of Queensbury this 25th Day of Aprl 19 °1
.
SIGNED BY /� ' /,tom° 7724 ll for the Town of Queensbury
( Bu Id' �Inspector
TOWN OF QU ENSBURY
Irw APPLICATIOn FOR JJ ' # . P IT
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DATE: `-7f— TOvt'N" OF QUEENSBUR'
LOCATION OF PROPERTY FOR INSTALLATION 9 7 K2'' CA -4.RECEIVED
`` APR 241991
Owner's Name: —'rite, f : �
Address: . I / -, iArDG. & CODE DEPT,,
Installer' s Name: -fe ,,.w , (' Telephone:
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: Circle one: Rolling Steep Slope % of Slope
Soil Nature: Circle one: Loam Clay Other /Depth:
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what_de.pth? Feet
Percolation test: Circle one: not required required
Rate - Min. Per Inch
Domestic water supply: Circle one: Municipal P Other
If domestic water supply is a well :
Separation: Water supply from any septic absorption /o feet.
11-t
911
PROPOSED SYSTEM: Septic Tank /6174 ° ' t al . (minimum size: 1,000 gal )
TILE FIELD: Each Trench 3 (/ feet/Total system length feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used # /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.
I
SIGNATURE OF RESPONSIBLE PERSON: 5-7
: ..�... DATE:
awn of Queeniur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEP IC DIISSPOS SYSTEM INSPECTION
NAME t /e
LOCATION A.-
DATE 2 / C// PERMIT NO. 6/)/-fib /
SOIL TYPE - SaA4 - oaml- Clay
Percolation Test Required? YES NO
Percolation rate - Min/Inch
TYPE of\ SYSTEM: /
Absorption field, total length
Length of each trench ,5 0-5c�-Sp _ qy
Depth of trenches 2 /T
Size of P avel 147,
SEEPAGE TS4N er o ) 4
Size- t. X ft.
Gr size,
PIPING: ,, Size ype
Bldg. to tank (,S 7-l.Ue;
Tank to dist. box 9 pi/ .
Dist. box to field/p' : i-! ,ov i__.-
Openings sealed? ____ NO Partial
LOCATION/SEPARATIONS:
Foundation to tank !U ft. 4—
Foundation to absorption ft.1
Absorption to lot .ine ft -
Separation of pits:e; 4_ft.
LOCATION 0 SYSTEI.j PROP RTY(circle one)
Front - ear , Let `pide - Right side -
COMMENTS: I I,
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SYSTEM USE APPROVED Y S N
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B ldi g nspector
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TOWN OF QUEENSBURi
90' RECEIVED
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APR 24 1991
BLDG. & CODE DEPT
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