91-755 •
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date &Matt 2d 19
This is to certify that work requested to be done as shown by Permit No. 91-755
has been completed.
This structure may be occupied as a Septic Alteration
Location Ridge & Jenkinsvblle Rd
Owner Danny Gwi nup
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY x
No. 91-755
WARREN COUNTY, NEW YORK
•
0
PERMISSION is hereby granted to Danny Gwinup tart
OWNER of property located at Ridge & Jenki nsvi l l e Rd Street,Road or Ave. o•-•
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. 5.
5
1. OWNER'S Address is
Same 0
3
2. CONTRACTOR or BUILDER'S Name
Jay Sweet
a
IC
3. CONTRACTOR or BUILDER'S Address fD
Cal
4. ARCHITECT'S Name fD
pe
3
.r.
5. ARCHITECT'S Address .�.i
7Z
C.
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( ) 1/1
e+
7. PLANS and Specifications —0.
No. Septic Alteration to include: A 1000 gal. Tank as per plot plan
specifications and application fD
•8. Proposed Use a
C+
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 23, 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 23rd- Day of / October 19 91
SIGNED BY <✓ - , for the Town of Queensbury
Building and Zoning In ctor
OftSi
j TOWN OF QUEENSBURY / ��S
APPLICATION FOR. SEPTIC. DISPOSAL PERMIT Permit #
Fee Paid cf, 5, O )
11.! 991 - _-
Date: Al -, /"' / Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION:
Owner' s Name: nd J) /7 r,, 0 ,4
Owner' s Mailing Address: \ ► j ,.t' �'�-
Installer' s Name: (° ) (( �v , , 5 l� , , �..,,- Phone #: 7/- ,) 6 7,
Number of bedrooms (if residential ) : /2
Total daily flow (residential-compute @ 150 gal . per bedroom): :_) O _Z
Topography-Circle One:c:Flat„,i Rolling Steep Slope % of Slope
Soil Nature-Circle One:(San Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: ?Vot Required ;, Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal ( iieli) Other
If domestic water supply is a well - — f
Separation: Water supply from any septic absorption ,,- feet
PROPOSED SYSTEM: Septic Tan " --17) gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s): Number of / Size each: ft. x ft.
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 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. "M l
f0 /`
SIGNATURE OF RESPONSIBLE PERSON: '' _ a/ 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
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:
awn o f Queeniur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME ( kl I i A1JU U{'
LOCATION C2 k '')Ca& 143
DATE /0/2-51/ I/ PERMIT NO. 9L'75s
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 PITS4Number of)
Size- ft.x X ft.
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. b x
Dist. box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS
Foundation to think ft.
Foundation to *sorption ft.
Absorption to of line ft.
Separation of aiDits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMM NTS: K/0 DQ C A-
,v 4 I f 4(-1-e---0
Aro L(,v4-s is-Xposo raVt
SYSTEM USE APPROVED NO
1)
ilding nspector
01/86 and vl
6)
.r."1
...,,
\ ,
/
!1 /To ( Orifri
........_,....... ..__ ______.
1
It'---
,...-
+21614(1--
i
7 b t t)/06.1, , ,,,,„..,,,,,,.
— -,
1 ,
,
, 1
(71)
\- 1
.._ 1
.4,
..,
) . ..,
4\ ,.
r-,,
TO,, , e , p 5,
`,;,.. „,/ '4: (k .
BUCLD'i'40 45', L •,..4.7., 4,;t. ,r ,
'\r
k,•_, ' , , . . •
! ,
/ I \
1 VATE ,73
'\R._
I'- `/ C'' 61 ‘ .•