1989-422 i'3i'a`L:;
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I CERTIFICATE (XF COMPLIANCE
TOWN OF QUEENSSURY
WARREN COUNTY, NEW YOR'K
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Dare December 11 19 90
�ihis is to certify that work requested to be done as shown by Permit No, 89' 4 22
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has been completed,
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This structure may be occupied as a Sewage alteration
oocation"` Boss odd
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1 Owner . Shane Ross
By Order Town Board
TOWN OF QUEEN8BURY
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Director of Bldg. do Code Enforcement
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BUILDING PERMIT
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TOWN OF QUEENSBURY No. 89-422
WARREN COUNTY, NEW YORK
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PERMISSION is hereby/ggrranted to SHANIE RO S
OWNER of property located at BOSS ROAD _ _ Street, Road or Ave.
in the Town of Queensbury, To Construct or place a SEWAGE 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.
t_ OWNER'S Address is
RD#4 Box 547
Queensbury, N . Y . 12804
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2. CONTRACTOR or BUILDER 'S Name 'r
Ron Dufour Con . ?
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3_ CONTRACTOR or BUILDERS Address
4_ ARCHITECT'S Name
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5. ARCHITECT'$ Address �.
6. TYPE of Construction — (Please indicate by X)
{ ) wood Frame { ) Masonry ( ) Steel ( I
7. PLANS and Specifications
No. 1000 gal . tank only as per plot plan and application .
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S. Proposed Use
Sewage Alteration rr'
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$ MOO PERMIT FEE PAID — THIS PERMIT EXPIRES June 12th 19 91 MM4
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(If a longer period is required an application for an extension must be rnade to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury thi 12th kCn;i�Wctor
June 19 89
SIGNED BY ---ti r%fv' for the Town of Queensbury
Building and Zoni
FOWN OF QUFENSBURY
&1,0APPLICATION FOR TOWN OF OUEENSBURy
o ;.", '`` RECEIVED
SEPTIC DISPOSAL PERMIT
BLDG. A CODE DEPT,
DATE
LOCATION OF PROPERTY FOR INSTALLATION Cx_`i5 RfyA.1,
Owner's Name: �!5 �A rAN C Q tt", Telephone : -, '2r �k - 3r/ 9
Address: R.,b '-1 OC Y, � � '� �u * N
Installer's Name: }`� rJ i] Telephone: ;7 y`y
Number of bedrooms (residential only) ez
Total daily flow (compute rd 150 gal per bedroom ) f F0 4„gL i 45 � T)AY 1 ., L,-).gaiE _*3,*- ,L
Topography: Circle one: Flat Rolling Steep Slope % of Slope F71-A -T
Soil Nature: Circle one Sand Loam Clay Other - /Depth ; - Feet
Ground Water: At what depth ? Ajar.) " Feet
Bedrock or Impervious TMaterial: At what depth ? or-3F Feet
Percolation test: Circle one: not required required rate min. inch.
Domestic water supply: circle one; Rlunic p Well father
If domestic water supply is a well.
Separation: Water supply from septic absorption — feet
PROPOSED SYSTE " I : Septic Tank Jf po gal. ( minimum size: 1 . 00f) gal. )
TILE FIELD : Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of / Size each feet by feet Spy r TlN6t c ti
Size of stone to be used # /Depth or Thickness feet.
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: ! „%G -
DATE: 0S ` Eli
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OVER
DATE � ��
Septic System Inspections :
applications for septic system installation , alteration or repair ,
as required by the Town of Queensbury Sanitary Sewage Ordinance , shall
be submit--red to the Building Department at least 24 hour } before start
of construction and shall include a plot plan silowing :
1 . ) t lie proposed location of tite sys tom,
? . } location and distance to lot lines
3 . ) location and distance to Structures
4 . ) location and distance to any water supply
5 . ) size and dirrwansions of all tanks , distribution boxes ,
the fields and / or drywells
L' . Nu �ystem shall be covered before inspections and approval by the
luilding Inspector . Failure to comply with this requirement may
result in rite uncovering; of the systelu by the installer and a fine
of up to $ 250 . 00 .
C . Pkn ipproved 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 installa—
tion , alteration or repair of an approved system , a new proposal must
lie submitted to the Queensbury Building Department before further
construction .
Tosco of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Toads
Queensbury , New York 12804
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PROCEDURE CSFP 502
9/ 15/83
SPECIFIC WAryER TL 83_ 5
Attachment 1
From R"uirxments of Part 75 (MY$ Sanitary Code )
for
Cndividuai Household Sewage 01sPosal Systems
f E::EP.AL TOI; (AoPlicant Complete)
of Alavl .f_ant . Ross Shane
Oast 1iame ri r$t ••
Address : RD 4 , Sox 547 Queensbury NY 12804
o. treet C I tyf if own state Z 10
Locatic " Boss Road Queensbury Warren 12804
Ha . tree( itv/Town Coonty T10
( APPLICANT - DO AOT WRITE SELCW nl[ LCYEI
1 . PEASOti ,wY SiTS DQES NOT MEET PART 75 OF xYS SAI:ITART LADE ; ( check aooropriate aox( s ) )
: Praration C` stance cannot 5e achieved .
L=: = scesslve SloDe .
r—p
:- f rr. a^oundwater .
: nadecuate oe7Ln to bedrock or imoer able laver•
S. asl unsuitable -
' _per (exalai r.)
Sep *_ ic tank will be less than 10 ' from dwelling and property line. . This
ins _ allation will replace an existing tank in same location .
Z . ?cr.;,-.5: : OrSir:,; OF. CS:IQ: TTOvS OF S4AIYrR :
Hou s4 i s on a slab
3. TuE P9"'m5r!1 DESif"t PAY HAVE THE FOLLC$WTUn LIMITATInHS - (check apnrooriate box (s ) )
fn:reased risk of well or soring contamination.
: ncreaSed risk of surface water contamination.
; ncreased risk of SnadeauatelY treated se4.age on the ground surface.
M FzPected desinn life of the system will be diminished.
F`" roeration of sewage system 1s Subject to mechanical problem¢ _
l`1 ,-.-her (explain )
-Acitlonal Information htrached
Const rVc ti cr. �,u rsuant to thin waiver reoue St should not nose env foreseeable health Or environmental nroblems , In
accordance w' ;.n New York State Department of Health Administrative Rules and Pequlations , Part 75 . 6 (b) . a waiver is hereby
Granted. -t. i7 waiver may be revoked by the lssuiny official for it change in conditions for which this waiver vas gran tea.
i ORISINAL - Local Health Anencv
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COPY I - APolicant
- --�'-' COPY z - bureau of Com. .nity
7,)' Strict cnc ,. ^eer or County Health M,!ninlsirator/Date $dnitatibn 3 Safety
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aevn o/ 'Queenehaery
BUILDING and ZONING DEPARTMENT
Bay and Havifand Road, R.D. 1 Box 98
Queensbury, New York 12801 #
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SEPTIC DISPOSAL SYSTEM INSPECTION
NAME �� cam- � �i �c7S_„1imV 1
LOCATION s
DATEI PERMIT NO -__
SOIL TYPE - an Loam - Clay -
Percolation est eguired? YES - NQ
Percolation rate - Min/Inch _
TYPE of SYSTEM: 4'
Absorption field , talr�ngth
Length of each tren h
Depth of trenches
Size of gravel
SEEPAGE PITS#N afiber of)
size- £ x - ft.
Gravel sizM
PIPING : size ,
Bldg . o tank -
Tank to dist. box
Dist. box to field/ t 1py
Openings sealed? S NO Partial
LOCATION/SEPARATI S :
Foundation to tank _
Foundation to absorption _£t.
Absorption to lot line ftv
Separation of pats ft.
LQCATIQN OF SYSTEM RQP]ERTY (circle one)
Front - Rear - ft side - Right side -
CCHMENTS :
SYSTEM USE APPROVED E5 NO
B ding In ector
01/86 and vl
AVrAL *W 4"
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.AWN or OUEEt4s
zoning miniator
Mr . Shane Ross
RD 4 Box 547
Queensbury , NY 12804
April 18 , 1989
New York State Department of Health
I) I- strict Office
2L Bay Street
CLens Falls , NY 12801
Whom It May Concern :
On October 25th 1988 , I was granted a variance for changes on
. t7: i= septic system . As per section D of the variance approval , I
must be granted approval from your office before I can secure a work
p .armit from the Town of Queensbury .
At this point in time the septic system has not failed , however ,
I believe the existing tank is metal and is starting to collapse .
I wish to correct this problem as soon as possible before major
corrections are needed .
If you have any questions feel free to contact me at
518 - 792-3119 .
Sincerely ,
Shane Ross