1987-070 BUILDING PERMIT
TOWN OF QUEENSBURY No 87-70
WARREN COUNTY, NEW YOiRK
aCAry
PERMISSION is hereby granted to Richard Bird i
a
9 Heinrtck St . Street, Road or Ave. F '
OWNER of property located at �-
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Sewage Alteration r''
in the Town of Queensbury, To Construct or place a
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.
F2CONTRACTO
R'S ] Heinrick St .
Queensbury , New YorkR or BUILDER 'S Name Pro—Craft •
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3. CONTRACTOR or BUILDER'S Address Peggy Ann road.
Queensbury , New York
4. ARCHITECT'S Name
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5_ ARCHITECT'S Address
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6. TYPE of Construction — (Please indicate by X)
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I ) wood Frame I ) Masonry I ) Steel ( } i::s
7. PLANS and Specifications
1000 gallon drywell and dista box per plot and application
No,
S. Proposed Use
Sewage System for dwelling
$ 10000 PERMIT FEE PAID — THIS PERMIT EXPIRES _ Mnrrh 18
(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.)
18tk1 March 19 87
Dated at the Town of Queensbury this Day of
SIGNED BY �-{ 4 for the Town of Queensbury
Building and Zoning Inspector
TOWN OF
APPLICATION FOR SEPTIC DISPOSAL PERMIT
fMA?,l 1 1987 --
/ / BUILDING 8c ODE DE t.
DA77E
LOCATION OF PROPERTY FOR INSSTALLATION
Owner's Name: ,r��' +�is '✓fi Telephone; c�'
Address: Qf // -7j0V + C�C S 7 C}
Installer`s Name: U /04?�00i�4 F7- Telephone:
Number of bedrooms (residential only) � 3
Total daily* flow (compute @ 150 gal per bedroom)
Topography: circle onf: ` at} Rolling Steep Slope 96 of slope
Soil Nature: circle one``- an 'Loam Clay Other / Deptht 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:Q
Well Other
IF domestic water supply is a Well:
Se_Zaration: Watersupply from Septic absorption _ feet
CLAJ
PI;H D SYSTEM : Septic Tank /� &kjo gale (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S) : Number of / Size each feet by feet
Size of stone to be used # / Depth or Thickness feet
IMPORTANT
...Please...LIST NEW EQUIPMENT TO BE INSTALLED
(over)
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, 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 installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction,
l have read the regulations above and agree to abide by these and all requirements
Of the Town of Queensbury Sanitary Sewage rz:Y sal e.
Signature of respon 'bl rson: y
Date :
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 79z-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD- PLACE TO LIVE
own o� Queeras �urr�
BUILDING and ZONING DEPARTMENT
Bay and Hawiland Road, R.D . 1 Box 98
Queensbury, New York 128Oi
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME C In.A.�i
LOCATION CF
D7,TE �+� PERMIT NO.��I---
SOIL TYPE --(:Sand - Loam - Clay NO
t Required? YES
Percolation
Percolation rate - Min/Inch _
TYPE of SYSTEM:
Absorption € ield , total length
1'ength of each trench
Depth of trenches
Size of gravel.
SEEPAGE PITS-(Number €t�
size- l2-Et. X �_
Gravel size
S i ze 'hype
PIPING * ^-
Bldg . to tank ` P(l
Tani to dirto box t ,..
field/ ••
Vista box to YE NO Partial
Openings sealed? gyp /
LC)CATTON/SEPARATION S : ..�.�
Foundation to tank
Foundation to absorptionAbsorption to to lot line
Separation of pits PROPERZY (circle one)
LOCAgC3N OF SYSTEM Right side
ron -- Rear - Left side
TS :
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SYSTEM USE APPF49Yi7ED YES NO
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