88-209 BUILDING PERMIT
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TOWN OF QUEENSBURY No. 88-209
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Bill Tierney
OWNER of property located at Cleverdale Road Street, Road or Ave.
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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.
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1. OWNER'S Address is I-a.
RT #4 Upper Fout Grove
Slingerlands, New York 12159
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2. CONTRACTOR or BUILDER'S Name
Adirondack Contracting
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name h
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5. ARCHITECT'S Address p,
6. TYPE of Construction—(Please indicate by X)
( 1 Wood Frame ( )Masonry ( )Steel ( )
7. PLANS and Specifications
No. 1000 gal. septic tank, 1 distribution box.
As per application and plot plan. m
8. Proposed Use
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Sewage Alteration
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$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 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 11th Day of May 1988
SIGNED BY M Q E)- for the Town of Queensbury
Building and Zoning Inspector /., L
0;01- of Queau141
} APPLICATION FOR SEPTIC DISPOSAL PERMIT �QQ�- •�
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14,f.Y ,�
_„` BUILDING & CODE [ pT,
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DATE -a / >, ,'
LOCATION OF PROPERTY FOR INSTALLATION (I(cuw"Lkc- Nty1
Owner's Name: �.\\ -\ t c v v- Telephone: 4 5-4, 3 5,7'-Z/'r 31 le"c'F
Address: / ,j_ /�
i^� #� ( lrri, L..C,L`1_ lL•1 c tic_._ 4311�t ;(7. ' /CLi�((. /"� / Z/ ")
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Installer's Name: , c,l1,v,,•v..c""1t',<�lC -,, -{ .-4.,c-{,v,,1 Telephone: C, e-< _. ;z>f.ee
Number of bedrooms (residential only) 3 _
Total daily flow (compute @ 150 gal per bedroom) '1 L'
Topography: circle one: .later. Rolling Steep Slope % of slope _
Soil Nature: circle one: Sand EamJ Clay Other / Depth: feet
Ground Water: At what depth? .+ feet
Bedrock or Impervious Material: At what depth? _ g /t feet
Percolation test: circle one: not required required / rate 7 min. inch.
Domestic water supply: circle one: Municipal , Well Other /l 6-c ,=e-
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption _ feet
PROPOSED SYSTEM: Septic Tank / Z— gal. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench 3 7 feet / Total system length ZZ-Z feet
Number of / Size each feet by feet
Size of stone to be used # Z, / Depth or Thickness / feet
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * V
IMPORTANT
_", ...Please...LIST NEW EQUIPMENT TO 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: i
Date: 1'/9/e6
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
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_.Jocun o/ Queen Jbur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME iE% /.c.�/1/h,
LOCATION egell-(/L igle.
DATE 6 / irPERMIT NO. OD -ceg79
SOIL TYPE - Sand - Loam - Clay -
Percolati•n Test Required? YES - NO
Percolation rate - Min/Inch
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TYPE of S .TEM:
Absorption field, total length , Z L
Length of -:ch trench
Depth of tr:nches j/
Size of gravel _
SEEPAGE PITS{ umber of)
Size- ft. _ ft.
Gravel size
PIPING: size Type
Bldg. to tank ‘f�i
Tank to dist. box Aw
Dist. box to field •it /" L
Openings sealed? S NO Partial
LOCATION/SEPARAT ONS:
Foundation to t. k 1 eft.
Foundation to -.sorption t.
Absorption to of line ft.
Separation of pits t.
LOCATI• , . SYSTEM ON PROPE' Y(circle one)
Front Pear Left side - Ri.ht side -
COMMEN ' tda `
d 76v( l,� l
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SYSTEM USE APPROVED S NO
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Building Inspector
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