1987-380 BUILDING PERMIT r
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TOWN OF QUEENSBURY No.
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WARREN COUNTY, NEW YORK
Ed Matte �
a.
PERMISSION is hereby granted to Road or Ave.
r located at 19 R.ichardson
Street, w
OWNER of property
Sewage alteration
in the Town of Clueensbury, To Construct or place a her witri plot plans and other information hereto filed and
at the above location in accordance to application toget
approved and in compliance with the Town of Q,ueensbury Building and Zoning Ordinance.
1 . OWNER'S Address is t"
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19 Richardson
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2. CONTRACTOR or BUILDERIS Name
m
,]IM Hermance
3. CONTRACTOR or SUILDERAS Address
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4. ARCHITECT'S Namerl
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5. ARCHITECT'S Address
6. TYPE of Construction — (Please indicate by X)
[ I Wood Frame [ ) masonry [ Y Steel [ 1
7. PLANS and Specifications Its per
No. 1000 gal septic tank , Dist . Box , & 2 6 ' x 8r seepage p
plot plan and application
a. Proposed Use
Sewage system for dwelling
A All
AAAAA June 229 1989
ISsi
10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES
tenon must be made to the Building and Zoning inspecto
r of the
[If a longer perms is required an appliesion for an ex
town of Queensbury before the expiration date.} 87
22nd p ay of June 19
Dated at the Town of Clueensbury this
for the Town of Queensbury
SIGNED BY Building and 4„� ing Inspector
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APPLICATION FOR SEPTIC DISPC7SAL PERMIT
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BUILDING & CODE DEPT
DATE
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: Z Telephone:
Address:
Installer's Name; 7F i b-�l fze[- -era , Telephone:
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) _ I
Topographys circle ones ,.r�.'l--a-t Rolling Steep Slope 3�0 of slope
Soil Nature: circle one:~_ Cd' Loam Cl a Other f Depth: _ feet
Ground Water: At what depth? _ / feet
Bedrock or Impervious Materials At what depth? � ""��^ feet
Percolation test: circle on not require equired / rate min. inch.
Domestic water supply: circle e: Mu ipal Well
IF domestic water supply is a Well: feet
Separation: Watersupply from Septic absorption
PROPOSED SYSTEM: Septic Tank C gal. (minimum size: 1 ,000 gal-)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S) : Number of f Size each -40 feet by feet
Size of stone to be used # �; , / Depth or Thickness ,�%� feet
IMPORTANT
...please...LIST NEW EQUIPMENT TO BE INS"f ALI.JM
(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, 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.
Co. 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 worts, 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: { - � y�,. y�zt .r•
Date.• , !
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE
Of
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road. R. D. 1 Box 98
Queensbury. New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
op
LOCATION. 4..
DATE �I E RM I T ND . /
SOIL TYPE -( San - Loam - clay -
Percolation Test Required? YES
Percolation rate - Min/Inch
TYPE of SYSTEM: total length
d
Absorption fiel ,
Length of each trench
Depth of trenches
size of gravel.
SEEPAGE PITS4Numbe of)
Size- �ft. X _ ft.
Gravel size
PIPING -. Size 'type
Bldg . to tank �—
Tank to disc . box
Dist . box to field/ Partial
openings sealed? 0
NO
LOCATION/SEPARATIONS - ft.
Foundation to tank E►
Foundation to absorption ft-
Absorption to lot line ft:
Separation of pits Q.,,one3
LOCATION OF SYSTEM ON PROPERTY
Front
Rear - Left side igkide�-
COMMENTS .
SYSTEM 2.35E APPROVED /YES NO
Building Inspector
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