94-341 400
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 42.1 6' 19 9
This is to certify that work requested to be done as shown by Permit No. 94-341
has been completed.
This structure may be used as a septic system
Location 9 Belle Avenue
Owner Joseph Michelucci
111—a—# By Order of Town Board
TOWN OF QUEENSBURY
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Director of Building & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No 94-341
WARREN COUNTY, NEW YORK 'b
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PERMISSION is hereby granted to JOSEPH MICHELUCCI
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OWNER of property located at 9 Belle Avenue Street, Road or Ave.
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in the Town of Queensbury,To Construct or place a SPPi-i c� Al t era t ion
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 H
same
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2. CONTRACTOR or BUILDERS Name (�
Ronald Dufour
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3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
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5. ARCHITECT'S Address (D
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6. TYPE of Construction—(Please indicate by X)
(D
( )Wood Frame ( ) Masonry ( I Steel ( )
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7. PLANS and Specifications
Septic alteration to include1000 gallon septic tank with
No. 135 feet of tile field at 45 ft. lengths with #2 stone
as per plot plan. S.
8. Proposed Use
Septic system
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$ 25 . 00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 29 19 96
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the 0
town of Queensbury before the expiration date.)
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Dated at the Town of Queensbury this 2 9 th Day of June 19 94
i for the Town of Queensbury
SIGNED BY /�(��.
R,, and Zoning Inspector
01106.
TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL P 1?T Permit # Q v ji /
/ 011, Fee Paid
I r glk •red
Date: �eceI aev i ewe_d By
LOCATION OF PROPERTY FOR INSTALLATION:
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Owner' s Name: , J . ,
. (�1t
Owner' s Mailing Address: q � p .�-� t.441L4Ati
Installer' s Name: i�z,^1 � �- Phone #: 71J-7 `/l'
Number of bedrooms (if residential ) : 04764 ,-44-0 ti:-v�
Total daily flow (residential-compute @ 150 gal . per bedroom): jld ?J
Topography-Circle One: Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipaj Well Other _
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank le o D gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench ".)_ feet//Total System Length / f feet
Seepage Pit(s): Number of / Size each: ft. x ft.
Size of Stone to be used: # / Depth or Thickness /A 2 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 1 `
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: /%t? DATE: �-Z`1r✓
0
, 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 repai— ui``an approved sys em, 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 & CODE ENFORCEMENT boor 0`—i
531 Bay Road Fes'
Queensbury NY 12804 '%', Kc,c'---E
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name t C \--it- yX,.
Location C.o94� 1a,_ of 3FLL. 1 kRA4
Date ,\91'1L Permit #
SOIL TYPE: _Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length ` y;
Length of each trench °IF
Depth of trenches Z�
Size of stone
SEEPAGE PITS: Number- ---
Size - . - ft. x - - ft.
Stone size
PIPING: 4,;-4 e Type
Bldg. to Tank r�
Tank to Dist. Box 1 %% .r
Dist. Box to Field/• ' <<
Openings Sealed? Iamb No Partial
LOCATION/SEPARATIONS:
Foundation to Tank r feet
Foundation to Absorptihn feet
Separation of Pits CMG
Conforms as per Plot/Plan�'r, ( _Ypsf feet
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side Side
Middle Frontle Rear
COMMENTS:
SYSTEM USE APPROVED: /T NO
Arrived: I a
Departed:
B d 4 , pec r
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REVIEWED BY I
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DATE
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