88-367 BUILDING PERMIT
TOWN OF QUEENSBURY gu
No. 88-367
WARREN COUNTY, NEW YORK °
PERMISSION is hereby granted to Patrick Stacavich co
OWNER of property located at Moon Hill 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 W
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2. CONTRACTOR or BUILDER'S Name raj
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3. CONTRACTOR or BUILDER'S Address
Same
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address IL
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6. TYPE of Construction—(Please indicate by X)
( 1 Wood Frame ( )Masonry ( 1 Steel ( 1 N
7. PLANS and Specifications rt
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No. 1000 Gal. Tank and 150' tile field
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8. Proposed Use
Sewage Alteration
$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 1 19 90
(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.)
Dated at the Town of Queensbury this 10th Day of June 19 88
SIGNED BY c7)
C�Lc(�' for the Town of Queensbury
Building and Zoning Inspector
APPROA4 0a.
\\ ...7:telt- of alai'1441
AlaravAM
k._\b APPLICATION FOR SEPTIC DISPOSAL PERMIT 1NING&OLDO CODES DEPT.
,, ,c1Owt Of uEENSluRY
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DATE 7/ /
" JUN 198$
BUILDING & CODE DEPT.
LOCATION OF PROPERTY FOR INSTALLATION 7/7 i! 2s9cc
Owner's Name: / 2-79c/gv/ Telephone: _ �f�5S/
Address: /�l7 r> /'y'i / 4/lf ���-� �� /� fiecS
Installer's Name: Telephone:
Number of bedrooms (residential only) _ v2 _
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one: Fla Rollin Steep Slope % of slope _
Soil Nature: circle one oam Clay Other / 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 CEP Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM: Septic Tank / gal. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench 56 feet / Total system length /5 U feet
SEEPAGE PIT(S): Number / Size feet liy
Size of - e to be used It / Depth or Thickne• feet
* * * * * * * 4 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
IMPORTANT
...Please...LIST NEW EQUIPMENT 1'O BE INSTALLED
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Section II 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 repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
•
I have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage Disposal. Ordinance.
Signature of responsible person:
Date: // 5.q
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
.1 : , ,, - T': - n r _ .r
7 awn of Queeniur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM` INSPECTION
NAME ,Dj /' Y/�i/'Z`
LOCAT I ONE /6 —/7 ,G .1)474/11 R
DATE j/6/Ap PERMIT NO. <6 '3(' il
SOIL TYPE - .. 0 - Loa i ' - Clay -
Percolation Te t Required? YES '"NO
Percolation rate - Min/Inch
TYPE of SY. EM:
Absorption f -ld, total ler•th / 7
Length of each rench 7p
Depth of trenche 2.• . r-T-
Size of gravel • .
SEEPAGE PITS{Number !,,,A
Size- ft _
Gravel ' e Ailic
PI* G: --r"- S ze Type
Bldg. to tank •
5CE4_L(O Pvc—
Tank to dist. bo - P v d-
Dist. box to fie d/per five_
Openings sealed ��::�%1 • five_
LOCATION/SEPA••TIONS:
Foundation to ank ft.
Foundation to absorption I. t.i.--
Absorption to lot line "tog-
Separation of pits - .
LOCATION OF S STEM ON PROPERTY(c rcle one)
Front - Rear Left side - Right .ide -
COMMENTS:
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SYSTEM USE APPROVED e I
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Build • nspec or
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