89-642 BUILDING PERMIT 1-3
TOWN OF QUEENSBURY
No. 89-642
WARREN COUNTY, NEW YORK o
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PERMISSION is hereby granted to Martin & Paula Johnsen
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OWNER of property located at 1730 Glen Lake 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.
1. OWNER'S Address is
Same
2. CONTRACTOR or BUILDER'S Name
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
1 Wood Frame ( )Masonry ( 1 Steel ( 1
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7. PLANS and Specifications
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No. Existing system, replacement of line only as per plot plan and application
8. Proposed Use ,
Sewage Alteration
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES August 10 19 91 f6
(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.) CD
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Dated at the Town of Queensbury this to Day of A iigust 19 R9 0
SIGNED BY for the Town of Queensbury
Building and Zoni Inspector
TOWN OF QUE NSPURY
APPLICATION FOR
TOWN OF QUEENSBURY
> SEPTIC DISPOSAL PERMIT RECEWED
C AUG 1 ) 1999
�? BLDG. & CODE DEPT.
DATE fJ' 'la
LOCATION OF PROPERTY FOR INSTALLATION /7$0 G L /1ii/pi '
' #,,e7/•'g`// -I V0///4/S )relephone: 2f' -5_/ 6
Owner's Name:
Address: /730 aGACA/ JI4 , yy. /,2 ey-S----
Installer's Name: Telephone:
Number of bedrooms (residential only) e2
Total daily flow (compute (d 150 gal per bedroom) c?4(2-0
Topography: Circle one: 410 Rolling Steep Slope % of Slope , L/7 T
Soil Nature: Circle one: Sand Loam Clay OtherC`/ /Depth: Feet
Ground Water: At what depth? Feet
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle one: not required required rate min. inch.
Domestic water supply: circle one: Municipal MN Other
If domestic water supply is a well:
Separation: Water supply from septic absorption 0L' feet
PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1,000 gal.) `-7
TILE FIELD: Each Trench feet/Total system length • feet ^ e ‘c
SEEPAGE PIT(S): Number of / Size each feet by feet
Size of stone to be used # /Depth or Thickness feet
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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 osal rdinance.
SIGNATURE OF RESPONSIBLE PERSON:
DATE: /l— j 01
OVER aa" :. w7,,::, '
REVIEWED
DATE /?///15- ,�
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 installa—
tion, 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 and CODES DEPARTMENT
Bay and Naviland Roads
Queensbury, New York 12804
Remarks :
Jouhn o f Queenitur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISF!OSAL SYSTEM INSPECTION
NAME (GUfbA QT �
LOCATION I
DATE 05l( / Q6 PERMIT NO. 8q-1v4a
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trerch
Depth of trenches
Size of gravel
SEEPAGE PITS{Numberof)
Size- ft. X t.
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box tr
Dist. box to field/pit',
Openings sealed? YES ', NO Partial
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LOCATION/SEPARATIONS:
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Foundation to tank ft.
Foundation to absorption ft.
Absorption to lc line ' ft.
Separation of puts ft.
LOCATION OF SYS'PEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
C ENTS:
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SYSTEM USE APPROVED YES NO
Building I spector
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