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1988-895s CERTIFICATE_ OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date February 13 ig 90 This is to certify that work requested to be done as shown by Permit No.88-895 has been completed. This structure may be occupied as a Maintenance Building/Addition Location RTE 149 Owner Fi.nch,Pruyn, co.Inc. By Order Town Board TOWN OF QUEENSBURY Director of-Bldg. do Code Enforcement BUILDING PERMIT H W TOWN OF QUEENSBURY b No. 88-895 WARREN COUNTY, NEW YORK o U PERMISSION is hereby granted to Finch,Pruyn and Co. ,Inc. N I OWNER of property located at Rte 149 Street, Road or Ave. w in the Town of Queensbury,To Construct or place a Addition to Maintenance Building 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 1 Glen Street Glens Falls, New york 12801 2. CONTRACTOR or BUI LDER'S Name Finch Pruyn and Co. ,Inc. x Paul Bromley d xxxxxxxxg RM KKK NM 3. CONTRACTOR or B U I LDER'S Address Z Kingsbury Road Box 573A Glnes Falls,New york 12801 0 4. ARCHITECT'S Name 7_4 n 5. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) rt CD r Wood Frame ( ) Masonry ( )Steel ( ) 7. PLANS and Specifications No. 26' x 30' addition as per plot plan,specifications, and application. , including, septic. 8. Proposed Use a. Maintenance Building p rt N• o 50.00 C/O 0 1 70.00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 1 1989 rt 0 If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the F; town of Queensbury before the expiration date.) W rt Dated at the Town of Queensbury this th Day of November 1988 m tn p SIGNED BY for the Town of Queensbury Building and Zoning Inspe or bi F_ PL QQ TOWN Or.QUEENSBURY APP1.I CAT T(IN POR BurLDIMG AND ZONING Pr.RmIT I Owl! UP Fee-Leved- 2 110 r r Reviewed u YL 1988 Fee Paid S / f BUILDING & CODE-DErPT, BUILDING AND.; CODES Ula'ARTPT:hFf Date Iacued 13AY and 11AVILAND ROADS .RD' 1 Box, 93 j :a L'r L 7 1UEENSDURY,NEIJ YOJRK 1?80.1 Penm-t t No. Q 9-0Tel (518) .79.2=5832 -Ext .204 70 0 A _PERNIT -h1US,r Ba OBTAINED BEFORE BEGINPIING CONSTRUCTION. NO INSPuCTIONS W1.LL BE 11ADE UNTIL- APPLICANT HAS RECEIVED A VALID_ BLILDINC. PERMIT. All applicable- spaces on .this application .must be- completed and the sinature of the applicant must appear on the - reverse.-side of this -sheet . is .,* * * '* A * * * * * * * Phe. owner of .this Property - is : Finch, Pruyn and_. .Co. , Inc. 1' . 0. Address 1 G1 en tr t, Glens Falls, NY. 12801 TEL. 793-2541 ext. 322 Property- location .Route 149 TAX MAP, N•O. 2 /Z/ 18 11as - there been .any split of _this - property. .since October 1 , 1988? ' /,. No'. yes no. If yes , Planning Board Rev-iew is necessary. SUBDIVISION NAME' ,. IP APPLTCABLE - N/A LOT NO.N/A e person responsible for suh.ervision of work :as regards .Building Codes, is : Mr. Paul Bromley Kingsbury Road Box 573A 747-9361 IJA,ML•' P .O . ADDRESS;, TEL. .NO. Name of builder Finch, Pruyn & Cotlddress Same as above Tel 793-2541 or Naive of Plumber_Address Tel 747-9361 Name of. Mason Address Tel 14ATURE OF PROPOSED 6011K: ZONING 1N1OI:rIA'1'ION (office, use on1"y)or Con:;cruet ion of a. now building Jr ZONING. DESIGNATION OF PROPERTY X Addition to a building Jr. PERMITTED PRINCIPAL PERMITTED ACCESSORY AltufaLion to ;i building . no ch:uuqu to, 0xc.:r.ior d linen:.•ipns) ' REVIEW REQUIRED PLANNING BOARD ' ZONING BOARD_ Ocher work (dos:cr.iLu) SITE PLAN'REVIEW # APPROVED DATE- VARIANCE I, CkOSS ARL"'A 01•' vitOPOJLD, J'1'Ruc,ruliE ' VARIANCE # APPROVED DATE l::t Ploor 780 sq, ft . RemarksAr 2 nd Floor N/A sq" f t . CQkVL.LTL.Z.IcJP ORmATION 1d:QUIRED LI.L U61. Other Floors N/.A sg ft.. Sixo of- property 18. 1/2 ac. cc- x ft. - not cellar or basement) L•:xistiIlg pudding( ) izu l'L' _x t C.. Ar TOTAL FLOOR- AREA 780 sq f t . 1:Xi::cin9 "builainy (C) Ur:u Maintenance garage izo of -new ::tructturo .26. ft 1. 30 voLuid:Ation-pier slat, crawl/liartial/full ' Vxopo:;vd building, discancu iron property lino rclu one) Front .yard.- '1225 ft Rear yard 3600 f t No, of. stories (habitable !apace) one rd::Side weight (grade to ridge). 13 fr. # y Inn rt Lind c It on. cornifresidUALiul,, no: of fan ilirs corner, .:;c;rbaa:k_ from SLdL• scr.aa:t n/a is No. of room-;lexcluding b:th!A. 4 OCCUPMLY INFORMATION 11o. of bedrooms; None PRIMARY IsUILDItJC - No. of bathropim; 2 One faiuily dwellingtrimary. huar-iris' sr;Ly: ,.:m. electric Two f:.cnily., duullinyryh of fu: i n/a dwcmultilo. llinc No. of firuplacu: to l, in::tall.:ci none " - 1 Number of units Perinancrrc occupwtcyWill " wuod :;L6%f: bu _insL:allud? n0 1'ransi nc occupar cy Cuntr:il Air COnt11ClU11ineJ? no Z1 uS1nCSS . BUILDING STYLE, PRIMARY Sl'RUCTURE r Industrial lua cl Coiie,ul:or..ry Lore cabin; 1 isod rant! M nsiun Dul lux If .,ddiciun, what will u::e b.:? Office: lunch Jhlic luvol old scyl u. L .410w room; dressing. room: C.,Vu Cod Cott:,go Ocher ACCESSORY .BUILDING- n/a Colorli"l• kola Tow II 11ouse ' rjecach::d yarugc/ono car/ two car/. car CIRCLL•'"ONL .PLEASE. ) s Atta'chud garaqu/one .car/ two cat/ Car' w i 1 * . • : i f /_ ; _PriVaLd SLOCUgO building - L.STIMATED MARKET VAI_u1 ' 01F, Ochec . INPORMA'PION ON IIUILDINC" SPPCII'ICATIONS', ON .VERSE SIDE SIDE OF. THIS -HI:ET, TO BE COMALG'1'L'A1 Form DPA I0/88 v1 BUILDING PERMIT APPLICATION CONTINUED BUILDING SPECIFICATIONS: Type of. construction, wood frame, fire safe,etc. wood frame Will any second-hand or ungraded lumber be used? .If so, for what? no Foundation wall material concrete Thickness 8" Depth of foundation below grade (to bottom of footing) 4 feet Will there be a cellar? no Heated or unheated? n/a Floor sq. footage 780 sq ft Will there be a basement? n0 Will any portion be used as living space? no If so, what portion? n/a sq.ft. - - Type of use? N/A Type of roof - sloped flat/shed/other Material• of roof . corrugated metal Size, wood studs X 6 spacing 24 "o.c. length 7 1/2ft. Joists(floor beams) lst. floor n/a "X spacing o.c. span ft. Joists (floor beams) 2nd. floor n/a "X spacing o.c. span ft. Overlays(ceiling beams) n/a "X spacing o.c. span ft. Roof rafters n/a "X spacing o.c. span ft. Roof trusses (pre-engineered) spacing 24 "o.c. span 26 ft. Exterior wall finish painted Of what material? metal Interior wall finish sheet rock /wall paper/paneling If a garage is to be attached, describe materials to be used for FIRE SEPARATION: Concrete block wall (existing) Is there to be an opening between garage and dwelling? yes If so will a Fire-rated door, enclosure, and self-closing device be provided? yes Will a flue-lined chimney be installed? no Height above roof ft. Depth of chimney foundation below grade n/a ft. Depth of fireplace hearth n/a ft. in. Water supply - Municipal or private well private well SEPTIC SYSTEM _ Distance from ANY private well(including adjoining properties 'js"' ft. A separate application is necessary for any repair or new installation of septic system) DECLARATION To the best -of my knowledge and belief the statements contained in this application, together with the plans and specifications submitted, are a true and complete statement of all proposed work to be done on the described premises and that all provisions of the BUILDING CODE, THE ZONING ORDINANCE, and all other laws pertaining to the proposed work shall be complied with, whether specified or not, and that such work is authorized by the owner. Signature Owne P, owner's agent, architect, contractor SPECIAL CONDITIONS OF THE PERMIT: By TOWN OF QULENSBURY WARREN COUNTY NEW YORK Application for: . BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STA12E ENERGY CONSERVATION CODE. A permit must be obtained before beginning. wo.rk. ANSWER ALL of the following: 1 . Gross floor area 780 sq ft 2 . Type of heat electric base board 3 . Is the building mechanically cooled? two rooms/windown units 4 . Percentage of area of windows and doors 8% A. Over . 16% Only 1 . Uo value of gross area of walls, roof/ceiling and floors exposed to ambient conditions 2 . Floor over heated spaces YES NO a. Are foundation walls insulated?YES NO 1 . If YES , what is the R value? 3 . Slab on grade. YES NO a. If YES , what is the R value ,of insulation around perimeter o.f floor? 4 . Is basement heated? YES NO . a. R value of insulation 5. Type of insulation B. Under 16% Only 1 . 12 value of roof and floors- exposed to ambient conditions_ Ra8 2 . R value of exterior walls R-1_8 3 . R value of glazed area.g7 7 4 . R value of doors 14.7- 5 . R value of floors over unheated spaces N/A 6. R value of slab edge insulation - unheated slab R-5:: 7 . R value of slab insulation '- heated slab N/A S. R value of heated basement/cellar walls (above grade) N/A 9 ., R value 'of heated basement/cellar walls (below grade) N/A 10. Type of insulation Fiberglass C. Controls 1. Thermostat maximum heat setting 70 . D. Duct Systems 1. Is .duct system, installed in unheated spaces? YES a. if YES , R . value of duct installation n/a b: -R -value of du.c_t.. in other areas n/a E. Pipinq Insulation 1. Size of hot water 'or cooling carrying agent pipe n/a 2 . R value of pipe insulation n/a F. Service Water Heating 1 . Performance efficiency n/a 2. 'Pemperature . control setting maximum n/a G. For Swimming Pool Only 1-. Maximum heating n/a Telephone No. 793-2541 applicant ' s signature) TOWN OF QUEENSBURY APPLICATION FOR SEPTIC DISPOSAL PERMIT DATE November 2. 1988 LOCATION OF PROPERTY FOR INSTALLATION On Rte. 149 near Wash. Co. Line 52-2-18 Owner's Name: Finch, Pruyn & Co. , Inc. Telephone•793-2541 ext. 322 Address: 1: Glen Street, Glens Falls , NY 12801 Installer's Name: Same Telephone: Same Number of bedrooms (residential only) N/A' Total daily flow (compute @ 150 gal" per bedroom) 140 "Qa1/day Topography: circle .one: Flat Rolling Steep slope % of slope Soil Nature: circle one:(Sand Loam Clay Other Depth:)'000 feet . Ground. Water: At what depth? 190 feet Bedrock or Impervious Material: At what depth? unknown feet Percolation test: circle one: not requiredTWell rate min.inch. Domestic water supply: circle one: MunicipaOther If domestic water supply is a Well: Separation: Watersupply from Septic absorption 100 feet PROPOSED SYSTEM: Septic Tank 1,000 gal. (minimum size: 1,000 gal.) TILL' FIELD: Each Trench a feet /_ Total system length 441Q feet- SEEPAGE PIT(S) : .Number of 2 / Size each 8 feet by 5 feet Size of stone to be used # 3 /Depth or Thickness 4 feet 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 Disposal Ordinance. . Signature of responsible person:_ u G Date: Agh 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 n 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, the 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 $250.00. C. An approved copy of the plot plan shall be available on the construction site. Failure_ to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installa— tion, alteration or repair of an approved system, a new proposal must be submitted to the Queensbury Building Department before further construction. Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury, New York 12804 Remarks: . lmwnu.r MAIN OFFICE ATLANTIC-INLAND, INC. 997 McLean Rd. NEW YORK Cortland,New York 13045 MEMBER OF N.F.P.A.AND I.A.E.I. Phone: (607)753-7118( 607)753- FIRE UNDERWRITERS 607)753-1396396 Electrical and Fire Inspection-Enforcing and Consulting Service) C 521 9 Incorporated in the State of New York) Desiring Certificate of Approval,application is made for inspection of electrical installation in the premises described below.On demand applicant agrees to pay for inspection service in accord with schedule of charges. APPLICATION FOR.ELECTRICAL INSPECTION—PLEASE P INT OR TYPE THIS SECTION TO BE COMPLETED BY APPLICANT DATE OF APPLICATION 4z ad CITY. OWN,VILLAGE Queensbury COUNTY -Warren STATE NY STREET ADDRESS BUILDG.NO. RURAL DIRECTIONS.On Rte. 149 just east of 9L intersection (south side) POLE NO. OWNER'S NAME Finch, Pruyn & Co. , Inc. OCCUPIED AS same OCCUPANT BUILDING—New Old WORK—New Additional CR OWNER'S P.O. ADDRESS 1 Glen Street, GlensFalls, NY 12801 APP.FOR—ROUGH WIRING FIXTURES OR READY FOR INSPECTION 19" FEE REMITTED—$ BY CHECK CASH MONEY ORDER MAKE PAYABLE TO ATLANTIC-INLAND,INC—NEW YORK Number of Rough Wiring Outlets 20Fixtures Add Installation Swtch I Lrtng Recap. KW Med. Mogul Fluor. 500 750 1000 1 1250 1500 1750 2000 2250 2500 2750 3000 Heat Base Base 6 Elect.Heat Amp.Service Water Htr.1 500 Burner Air Cond. Surface Unit Oven Range Gr.Disp. Dish W. Dryer H.P.Pump Ex.Fan Hood OTHER EQUIPMENT(Specify Type&Capacities) TYPE WIRING EN CONCEAL OTHER MA NOF MAIN CIRCUITSSIZEZOOA6OBRANCHESONO.OF 10 APPLICANT'S SIGNATURE LICENSE p PERMIT N APPLICANT'S NAME OF ADDRESS Gl en Street UTILITY Niagara-Mohawk L-11 OFFICENYZIPCODE12801BENOTFI Woodlands (PRBromley)CITY Glens Falls STATE BE NOTIFIED ROUGH WIRING AMP SERVICE K.W.SURFACE OUTLETS EQUIPMENT UNIT SWITCHES AMP SERVICE K.W.OVEN. CONDUCTORS H.P.GARBAGE RECEPTACLES H.P.PUMP DISPOSAL_UNIT MEDIUM BASE K.W. FIXTURES K.W.DRYER DISHWASHER MOGUL BASE K.W.WATER FIXTURES HEATER K.W.RANGE FLUORESCENT H.P.AIR AMP. RECEPTACLES FIXTURES CONDITIONER MERCURY VAPOR OR WIRING&CONTROLS FOR BURNER SMOKE FRAC.H.P. QUARTZ FIXTURES DETECTORS VENT FANS MOTORS,H.P. 1/20 1/12 1/10 1/6 1/6 1/4 1/3 1/2 3/4 1 11A 2 3 5 71/a 10 15 20 25 30 40 50 75 100 MARK NUMBER- OF EACH SIZE 500 1 750 11000 11250 1150011750 2000 1 2250 2500 1 2750 3000 LAPPARATUSElectHeat MISC.INFO.Received Inspected FEE PAID PROGRESS TOTAL$Stanley Matylza DEFECTIVE R it2, Box 6 Rough Whin Certificate Check No. Al.. D. 0p9 g g Greenwich, 1Y.Y. 12834 TemporaryService Money Order Mon. -Fri. 6 - 7.30 A.M.FINAL CERTIFICATE Cash Dup.Cent.Req. 518T 86 fi!B39, MUNICIPAL Charge MUN.ADDRESS TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12801 TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPORT REQUEST FOR INSPEC ON RECEIVED NAMEilrC LOCAT IOWZ- DATE 'l l PERMIT # APPROVED YES NO OTING/PIERSOMONOLITHICPOUR FORMS FOUNDATION DAMP-PROOFING BACKFILL AP OVAL ROUGH PLUMBIN FRAMING i ELECTRICAL ROUGH- INSULATION: FOUNDATION t FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING A EXTERNAL PORCHESISTEP71 STAIRS-CLEARANCE & ILS PLUMBING FIXTURES/RELIEF LVE INTERIOR TRIM/PRI&Y DOOR FINISHED FLOORS GARAGE FIREPROO NG DOOR CLOSER(S) SMOKE DETECTOS FINAL ELECTRICAL INSPECTION l FINAL APPROVAL, OF CONSTRUCTION A SIGNED &RTIFICATE OF OCCUPANCY ST BE OBTAINE7 FROM THE BUILDING DEPART M NT BEFORE THESEIPREMISES ARE OCCUPIED!- REMARKS: dg ro I. In TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12801 TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPORT REQUEST FOR INSPECTION RECEIVED ll -3 0 NAME CG-k1j LOCATION 1,11q G DATE f - -51 PERMIT # APPROVED YES NO FOOTING/PIE S MONOLITHIC P UR FORMS t FOUNDATION/D P-PROOFING BACKFILL APPRO AL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS ! STAIRS-CLEARANCE & RAILS' PLUMBING FIXTURES/RELI& ALVE INTERIOR TRIM/PRIVACYDOOR FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSER(S) SMOKE DETECTORS FINAL ELECTRICAL IYSPECTION FINAL APPROVAL OF I ONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPART NT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK I2809- TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPORT REQUEST FOR INSPECTION RECEIVED__,- NAME _ l/' LOCATION DATE a PERMIT # ' APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL UGH PLUMBING RAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS y, WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT.. ROOFING SIDING EXTERNAL PORCHES/STEPS` STAIRS-CLEARANCE & RAILS PLUMBING FIXTURES/RELIEF` VALVE INTERIOR TRIM/PRIVACY DOORS- FINISH ED FLOORS , GARAGE FIREPROOFING DOOR CLOSER(S). SMOKE DETECTORS FINAL ELECTRICAL INSPECTION r FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: v cw INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12804-- TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPORT REQUEST FOR INSPECTION RECEIVED NAME _gq- t if -/n, LOCATION I `i 1 DATE C7 PERMIT # - APPROVED YES INO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING, FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS r' WALLS CEILING FINAL INSPECTION: F CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS STAIRS-CLEARANCE & RAILS ',. PLUMBING FIXTURESIVELIEF VALVE INTERIOR TRIM/PRIVACY DOORS . FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSER(S) , SMOKE DETECTORS FINAL ELECTRICALL'' INSPECTION FINAL APPROVAL OF CONSTRUCTION F A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: I i INSPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12809-Py- TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION DATE _ PERMIT # APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS ;` STAIRS-CLEARANCE & RAILS PLUMBING FIXTURES/RELIEF VALVE INTERIOR TRIMIPRIVAC'Y DOORS FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSER(S) SMOKE DETECTORS r'e FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF," CONSTRUCTION f A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE f THESE PREMISESIARE OCCUPIED! REMARKS: INSPECTOR M cc Jown o1QU eenjburcy BUILDING and ZONING DEPARTMENT yy Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION 4 ` NAME LOCATION r DATE PERMIT SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES --NO Percolation rate - Min/Inch TYPE of SYSTEMi, Absorption field,, total length Length of each- trench Depth of trenches'., Size of gravely SEEPAGE PITS{Number of) Size- eft. X Gravel size PIPING: Size Type Bldg. to tank Tank to dist. box Dist. box to field/pit Openings sealed'?NO Partial LOCATION/SEPARATIONS: Foundation to tank 70 ft. Foundation to absorption ILL ft. Absorption ,to lot line ft. Separation?of pits ft. LOCATION OF SYSTEM ON PROPERTY(circle one) Front - Rear - Left side - Right side - COMMENTS:,i 1 SYSTEM USE APPROVE YES 0 Building Inspector 01/86 and vl