94-250 �3
BUILDING PERMIT
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TOWN OF QUEENSBURY 94-250
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No. Z
WARREN COUNTY, NEW YORK 0
MOUNTAIN VIEW MOBILE HOME PARK 00
PERMISSION is hereby granted to N
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OWNER of property located at Lot 3 Mountain View Rd Street, Road or Ave. N
in the Town of Queensbury,To Constructor place a Septic 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. td
1. OWNER'S Address is
Ivan Barsukoff
RD1 box 139F Rock City Rd x
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Hudson Falls NY 12839 It
2. CONTRACTOR or BUI LDER'S Name
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Bill Threw C
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name W
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5. ARCHITECT'S Address
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6. TYPE of Construction— (Please indicate by X) ~
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( ) Wood Frame ( ) Masonry ( ) Steel ( ) 0
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7. PLANS and Specifications
Septic alteration to include one 8 ' x 6 ' Seepage pit witl w
No. #3 stone at 2 ft. as per plot plan and application. F
8. Proposed Use rrt
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Septic system
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25 . 00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 3 19 96 �$
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(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 3rd D� June 19 94 N
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SIGNED BY ? / for the Town of Queensbury N
Building and Zoning Inspector 0
TOWN OF QUEENSBURY ,/�
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # _cr
Fee Paid
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Date: Reviewed By
LOCATION OF PROPERTY FOR INSTALLATION: ;' ; Mu
Owner' s Name: pL VL
Owner' s Mailing Address: ? �� 4elr
Installer' s Name: ; - �(,!� Phone #: -(7jd�
Plumber of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 gal . per bedroom) : J o(5
Topography-Circle One. Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? ,�Jf�- Feet
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other
If domestic .water supply is a well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank 6(30 gad. (Minimum size: 1,000 gal . )
Tile Field: , Each Trench feet//Total System Length feet
Seepage Pit(s) : Number of / Size each: ft. x ft.
Size of Stone to be used: # / Depth o Thicknes' feet
HOLDING TANK SYSTEM_..LF-REQU'IRE
No. of Tanks -- -�_ Size of Each
Alarm system and asso,ci•ated- electrical work to be tn-sperted- by a certified
agency. - -_
I have read the regulatidn�theverse side of this sheet and agree to abide
by these and a.11-- feeqqui rements of t2jvllul
Town of Queensbury Sanitary Sewage Disposal
Ordi nanc�e.
SIGNATURE OF RESPONSIBLE PERSON: / Z DATE:
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
anal/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.
Town of Queensbury
Building & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks:
TOW OF QUEENSBURY
BUILDING G CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
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SEPTIC DISPOSAL SYSTEM INSPECTION
Name ��' /J Rff-1Z5CJ 11C 0 rF
Location An 6 .
AOA
Date Permit #
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTE6i:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - _� ft. ,x ft.6Y.8'��5��'g�
Stone size -t+
PIPING: Size Type
Bldg. to Tank ) CAO
Tank to Dist, Box -�--
Dist. Box to Field/Pit
Openings Sealed? Yes., No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEK ONV PROPERTY:
(circle one)
Front - Rear - Left Side -`,Right Side
Middle Front ,Middle Rear
COMMENTS:
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SYSTEM USE APPROVED: YES
Arrived:
Departed:
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Building nspec r
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BUQ� ��� c ®E PT.
REVIEWED 3Y i.
DATE