1987-352 BUILDING PERMIT
TOWN N OF QUEENSBUR i No $7-352
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to ead Villa e
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OWNER of property located at Lots 115 and 1 Luzerne Road Street, Road or Ave. '
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in the Town of Queensbury, To Construct or place a Sewage Alteration
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Dueensbury Building and Zoning Ordinance.
1. OWNER'SAddressis P . 0 . Box 123
Hudson Falls , New York 12839 x
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2. CONTRACTOR or BUILOER'S Name Sanitary* Sewer Service
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3. CONTRACT+OR or BUILDER'S Address ~
P . 0 . Box 224
Glens Falls , New 'York
4. ARCHITECT`S Name
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S. ARCHITECT'S Address N
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6. TYPE of Construction — (Please indicate by X) 1"
( 1 Wood Frame { I Masonry ( I steel ( 1 1
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7. PLANS and Specifications v'
1000 gallon septic tank , dtst . box and 2 6 ' x8 ' seepage pits
No. xxxx per plot and application
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8. Proposed Use p
Sewage system for Lots 115 and 116 in mobile home park �
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$ 10 . 00 _ PERMIT FEE PAID — THIS PERMIT EXPIRES June l5 19 89
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(If a longer period is required an application for an extension must be made to the Building and 7_oning inspector of the N
town of ausensbury before the expiration date.l Oo
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Dated at the Town of Q.ueensbury this 15th Day of June 1987
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SIGNED BY for the Town of Gueensbury
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Building and Zoning Inspector /�r,/
TOWN L'F
APPLICATION FOR SEPTIC DISPOSAL. PERMIT JUN g 1987
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BUILDINIG a COUir C EP-P-
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LOCATION OF PROPERTY FOR INSTALLATION
s-'.. ►�' t Tele hone. y �c) �/ +o
Owner's Name: i P �r
Address: ., ll ' /2
Installer's Name: Telephone: C:;'
Number of bedrooms (residential only) — f�]r'� • r `� ��4�
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one: t Rolling Steep Slope % of slope
Soil Nature: circle ones a Loam Clay Other / Depth: feet
Ground. Water: At what depth? r feet
Bedrock or Impervious Materials At what depth? feet
Percolation tests circle one: of required required / rate min, inch.
Domestic water supply: circle one: Municipal Well Other � T
IF domestic water supply is a Well:
Separations Watersupply from Septic absorption feet
PROPOSED SYSTEM: Septic Tank `[ gal. (minimum sizes 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S) : Number of _02,� / Size each feet by s+ feet
Size of stone to be used # _ / Depth or Thickness feet
IMPORTANT'
...Please...LIST NEW EQUIPMENT 170 BE INSTA7-T-M
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Section II Septic System Inspections:
A. All applications for septic system installation, alteration or repair, as
required by the Town of Queensbury Sanitary Sewage CWdinance, 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 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 a to abide by these and uirements
of the Town of Queensbury Sani Sewage isposal Ordinance
Signature of r sponsible person:
Date:
01
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