1987-345 r3
BUILDING PERMIT �
TOWN OF QUEENSBURY No. 87-345
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Laster Waits trot
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OWNER of property located at Minnesota Ave . Street, Road or Ave. �
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Sewage Alteration ~`
in the Town of Queensbury, To Construct or place a eat
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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 Minnesota Ave .
Queensbury , New York 12801
2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer Service
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3. CONTRACTOR or BUILDER 'S Address 0
P . 0 . Boas 224 0
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Glens Falls , New York 12801 w
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4. ARCHITECTS Name
S. ARCHITECT'S Addrew
6. TYPE of Construction — (Please indicate by X) rfD
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( I Wood Frame ( ) Masonry ( 1 Steel ( }
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7. PLANS and Specifications r*
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No. 1000 gallon tank, drywell 8 ' x8 ' per p]ct and application
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B. Proposed Use
Sewage system for dwelling
10 . 00 PERMIT FEE PAID THIS PERMIT EXPIRES June 11 1g 89
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date.)
Dated at the Town of Queensbury this ---yllth Day of June Sg 87
SIGNED BY / / r for the Town of Queensbury
Building and Zoning Inspacto &P
APPLICATION FOR SEPTIC DISPOSAL PERMIT Jury 6
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BUILDING a CODE DE PIr '� �
DATE I
LOCATION OF PROPERTY FOR INSTALLA`T"ION
Owner's Name: �{ Telephone:.44
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Address: _ j`" f� Q Via ,,fy' D7A e—
Installer's Name: " C/ Telephone: `19 7 L4 52
Number of bedrooms (residential only) 2 _
Total daily flow (compute @ 150 gal per bedroom)
TcpograpLp: circle one: 1 t Rolling Steep Slope 9$ of slope
Soil Mature: circle one: San Loam Clay Other / Depth: 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. Municipa Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption _ feet
PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench r 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
I M P O R T A N T
W-.Please...IAST NEW EQUIPMENT TO BE INSTALLED
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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 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.
I have read the regulations above and a abide.by these and all xecluirements
of the Town of Queensbury Sanit wage C1�d=naa c
Signature of rqrsponpable person:
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
7otvn p/ Quee" 31urty
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury. New York 12801
SEPTIC DI SP AL SYSTEM INSPECTION
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NAME , 4
LOCAT I ON/
DATE G / PERMIT No .
SOIL TYPE - Sand - Loam - Clay
Percolation 'Pest Required? YES - NO
Percolation rate - Min/Inch T
TYPE of SYSTEM:
Absorption field , total length
Length of each trench
Depth of trenches
Size of gravel --
SEEPAGE P ITS-Rutnber o
Size- jD ft. X ft.
Gravel size
PIPING : Si" Type
Bldg _ to tank --
Tank to dirt . box
Dist_ box to field/
Openings sealed? YES NO
Partial
LOCATION/SEPARATIONS :
Foundation to tank Id, ft.
Foundation to absorption ft .
Absorption to lot line ` ft.
Separation of pits N ft.
LOCATION. ON PROP Y (circle one)
Front - ea Left side - Right side
COMMENTS .
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SYSTEM USE APPROVE YES
Sui ing Inspector
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