93-709 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
g
WARREN COUNTY, NEW YORK
Date /919 e.5
This is to certify that work requested to be done as shown by Permit No.93-709
has been completed.
This structure may be used as a septic system
Location 3 Ames Place
Owner Andrew Susalka
115-4-19 By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
6_ 616
BUILDING PERMIT
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TOWN OF QUEENSBURY
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No. 93-709
WARREN COUNTY, NEW YORK o
PERMISSION is hereby granted to ANDREW SUSALKA w
OWNER of property located at 3 Ames Place 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.
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1. OWNER'S Address is
same
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2. CONTRACTOR or BUILDER'S Name
Queensbury Sewer Service fD
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( 1 Wood Frame ( )Masonry ( )Steel ( )
7. PLANS and Specifications
Septic alteration to include 180 feet of tile field
No. at 45 feet lengths with #2 stone at 1 ft. as per plot
plan and application_
8. Proposed Use
Septic system �m
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$ 25 . 00 PERMIT FEE PAID —THIS PERMIT EXPIRES November 18 lg 95
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
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town of Queensbury before the expiration date.) (D
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Dated at the Town of Queensbury this 18 th of N tuber 19 93 ct
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SIGNED BY
GJ for the Town of Queensbury
Building and Zoning Inspector
A
TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
Fee Paid
Date: /I/ig/93 Reviewed B '`
LOCATION OF PROPERTY FOR INSTALLATION: 3 AmES /94/4c6- r J03
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Owner's Name: Se'6741_/5A To ted
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7 by 1,`n
Owner's Mailing Address: 3 f-1irics P4ic s� OepCry e,
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Installer's Name: .Jc,J 5� � Phone #: 7'?2 d -�
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom): 3°°
Topography-Circle One: Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth:
Ground Water-At What Depth? / -)o 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: Munic pa Well Other
If domestic water supply is a we l -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank gal . (Minimum size: 1,000 gal . ) ;c ,s-f;,,
Tile Field: Each Trench 'IS- feet//Total System Length l. C' feet
Seepage Pit(s): Number of / Size each: ft. x ft.
Size of Stone to be used: # .1 / Depth or Thickness / feet
**************
HOLDING TANK SYSTEM IF REQUIRE
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.
SIGNATURE OF RESPONSIBLE PERSON: -s_A-1( 7(— DATE: 1A �9 19.E
i
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
` ' construction and shall include a plot-plan showing:
1) the; proposed location of the system
2) Watti on and distance to lot lines
3) . ,ocation 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 apprpval by the Building
Inspector. Failure to comply with this requirement . may result in the
uncovering of the system by the installer and a fine--o 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:
t •
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT 531 Bay Road627
Queensbury NY 12804
518-745-4447
S UTIC DISPOSAL SYSTEM INSPECTION
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Name ap ,fe(-
Location _ 12(A7
Date ,t/// q/93 Permit # -7/g
SOIL TYP :. Sand)Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Ler,th l V
Length of each trench )
Depth of trenches „215: 7-7--
Size of stone :
SEEPAGE PITS: Number-
Size ._ ___-
- �;'X
Stone s --
PIPING: size Type
Bldg. to Tank I 7 -/,&2 --
Tank to Dist. Box 4,t f fr
- -- -Dist. Box to Field/P. - 14 Arc —
Openings Sealed? Yes No Partial
LOCATION/SEPARATION :
Foundation to Tank 6-kt5Tl,16—feet
Foundation to Absorption a {
eet-
S feet
Conforms as per Plot Plan 404. No
LOCATION OF SYSTEM ON PROPERT
(circle one)
Front - Rear - Left Si - Right Side
Middle Front - iddle Rea
COMMENTS:
CC.k,riertitc.1,0 ti,_/i---,S1-4.)41.b-5 eO6-c-cl I- -
SYSTEM USE APPROVED: YE NO
Arrived: ,or—
Departed: .,:;' ,11
Buildin./Inspe to
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