89-840 BUILDING . PERMIT
TOWN OF QUEENSBURY
No. 89-840 ,,
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to WALT ENGLERT
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OWNER of property located at Lake Parkway, Assembly Point 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
Box 1293 - Lake Parkway
Assembly Point
2. CONTRACTOR or BUILDER'S Name
GLENVILLE SEPTIC SERVICE
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3. CONTRACTOR or BUILDER'S Address
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70
4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
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( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. Existing 1,000 gal . tank, 250 trench system, as per application andcn
plot plan.
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8. Proposed Use a
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Sewage Alteration. -17
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 25, 19 91
(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 Queensbur 25th Day of October 19 89.
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SIGNED BY for the Town of Queensbury
Building nd Zoning Inspector
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I U WN OF Q UEENS B LTV
3 APPLICATION FOR
1 �-it' > SEPTIC DISPOSAL PERMIT
4111,
=DATE jr( — 3 -i ?
LOCATION OF PROPERTY FOR INSTALLATION LQka "Qrkuoc, ) ipsS t rA(5 Joy n T'
Owner's Name: LQJc)4- P,.,9 )i (-4- Telephone:
Address: RQ . ) 9.3 / k_s2_ P.r-kc�a IsSszmkI y �,r+ Qic.�onb�-�'�'�q
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Installer's Name: 6 L2_,NA V ti I . S -1-)e STh_Gp-t)) e Q Telephone:(E/8)'399-26-,2. V
Number of bedrooms (residential only) g
Total daily.flow (compute @ 150 gal per bedroom) ‘ea
Topography: Circle one: Flat Rolling Steep Slope % of Slope q - -- -_
Soil Nature: Circle one: Sand Loam lay Other 9 "✓r /Depth: Feet
Ground Water: At what depth? 4/ . Feet
Bedrock or Impervious Material: At what depth? d/--
Feet
Percolation test: Circle one: not required required rate min. inch.
" Domestic water supply: circle one: Municipal Well Other Lake Cre041-a
If domestic water supply is a well:
Separation: Water supply from septic absorption feet _
PROPOSED SYSTEM:. Septic Tank /J 67}27 gal. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench 6-0 feet/Total system length • '5Q feet
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 ide of this sheet and --e o a►,ide by,these
and all requirements of the Town of Qu ensbury anitary Se 40: i so :1 Ordinance.
/'
SIGNATURE OF RESPONSIBLE PERSO : pe...J _ ....e.-a, --- - -
DATE: fo1 ,__4•- P Cr .
OVER ,
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 Haviland Roads
Queensbury, New York 12804
Remarks:
Down o/ QueetEdury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME 4, /L �.�� /ta�
LOCATIONass, �/ ,"�`•
DATE / PERMIT NO. F;P - a yo
SOIL TYPE _ Sand - EZ; - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length 47../FT.,
Length of each trench _'-
Depth of trenches ' /-02
Size of gravel A .Z
SEEPAGE PITS{Number of)
Size- ft. X ft.
Gravel size
PIPING: Size Type
Bldg. to tank `7/ / C
Tank to (list. box y �/
Dist. boy: to-field/pit y 6/
Openings sealed? impNO Partial
LOCATION/SEPARATIONS:
Foundation to tank /o ft.
Foundation to abscrption 0749 ft.
Absorption to lot line /5 ft.
Separation of pits — ft.
LOCATION • SYSTEM ON PROPERTY(circle one)
Front Anil- Left side - Right side -
COMMENTS:
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SYSTEM USE APPROVED YE N
Bu' d g Ins ector
01/86 and vl
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