historical information TOE! OF QUEENSBURY
r BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSfiL SYSTEM INSPECTION
Name LW/5
Location 4Q6, G-t)
Date iiikAr Permit #
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone L�
SEEPAGE PI Number- SUN 10 2020
Size - ft. x ft.
Stone size TOWi4 p pr--S
PIPING: S'ze Type . BUIL.DN
Bldg, to Tank
Tank to Dist. Bo
Dist. Box to Feld/Pit
Openings Sea ed? Yes No Partial
LOCATION!/ Ao.TIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYS.iIY ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
•'l7c7-R `►A-fvvs 1 u fifx4-7:-
SYSTEM USE APPROVED: YES SP
Arrived: _
Departed: f1 '-
Building Inspector
TO MN OF QUEENSBURY .l
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensb ry NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name (-1`—th)
Location
Date lc- 17 Wmit # 6sa
1
SOIL TYPE: Sad-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tota en th
Length of each trenc
Depth of trenches
Size of stop
SEEPAGE PITS: N ber-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tani(
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption _ feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION. OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
7?\ AVb. 14�
Oak
FI \Y
SYSTEM USE APPROVED _YES NO
Arrived:
Depart
B ding Ins
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
' 742 Bay Road
Qneensbury NY 12804 •
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ,e/ex"-el":5
Location iCt*
Date ///z. jg Permit #
SOIL TYPE: and-Loam- -
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length S6
Length of each trench .d :v Lei,%P
Depth of trenches
Size of stone 2- -
SEEPAGE P TS: Number mow
-
Sion ft. x
Stone size
PIPING: AVz,e, Type
Bldg. to Tank
Tank to Dist. Box -TT- 7y46
Dist. Box to Field/'it V." Sz 0
Openings Sealed? Yes No Partia
LOCATION/SEPAL' :T;!I r S:
Foundation to T,.nk /, feet
Foundation to ' 'sorption , feet
Separation of 'its feet
Conforms as 'er Plot Plan e3 No
LOCATION OF YSTEM ON PROPERT :
(circle oa -A,
Front - L '' - Left Side (Right Si
Middle Front - Middle Rear,
CO 'IENTS
SYSTEM USE APPROVED: YES NO
il
Arrived:
Departed:
Building Inspector
Application for SEPTIC DISPOSAL, PERMIT
Town of Queensbury
Dept. of Community Development Permit No. i 1
Building &Codes Office OCT/ 98
742 Bay Road 19
Queensbury, NY 12804 Fee Paid $
Location of property for installation: 2. 4 6 /ie f r ( } (' XS:,J' 5Z
Property Owner's Name: ).¢jM + (A)r/!/`)9-✓1 €�
Property Owner's Mailing Address: 3 L�1 /7/0 on'' 11cI fig‘.:i L /0.; /2 41U
�'n��D4 ) 63,k- p�y6
Installer's Name: /� . /-SCCCAVi51-7e, l Phone #
7Y3-city
3
Number of bedrooms (if residential): % Total daily flow: 400
(residential - compute @ 150 gal./bdrm.)
Topography: .x flat, X_ rolling, steep slope % of slope
Soil Nature: sand, ` loam, clay, other /depth:
Ground water: at what depth?1'.9 feet / Bedrock or Impervious Material: at what depth? / feet
Percolation test: not required, required [rate min. per inch]
p9",4
Domestic water supply: municipal, well, other t'144.C.
If domestic water supply is a WELL, water supply from any septic absorption is,7-41)6 feet.
PROPOSED SYSTEM A ultio.t1 C>5` !� }�J Co Pr&, ) ) , F i>er AE /) 4:
Septic tank: 12SCkallon (minimum size: 1,000 gal.) /00 d . - Poi w 174
Tile field: each trench 60 feet / Total system length: 326 feet
Seepage pit(s): number of -- / size each: — ft. by ft.
Size of stone to be used: # Z I depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: — Size of each: gallons
� 1
Alarm system and associated electrical work to be inspected by a certified agency.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of
r
approvalgranted which is based or isQneensbury, anY.o make a
Pero upon granted in reliance upon any material misrepresentation or failure to a
material fact or circumstance known by or on behalf of an applicant, shall be void.
I have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: Date: / ls` f "
14*
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