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1987-341 BUILDING PERMIT TOWN OF +QUEENSBURY � No. 87-341 � . �� ... � .r. WARREN COUNTY, NEW YCiRK CD •PERMISSION is hereby granted to Vincent:: and Josephine 011veri I� 1 OWNER of property located at 55 Country Club Road Street, Road or Ave, 0 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 Queensbury Building and Zoning Ordinance. 1. OWNER'S Address is 55 Country Club Road Queensbury , New York 12801 c n 2. CONTRACTOR or BUILDER'S Name rD Hometown rt w a cE. 3. CONTRACTOR or BUILDER'S Address ram, Q Warrensburg , NY 12885 W `(D A. ARCHITECT'S Name ro Q w C m re 5. ARCHITECT'S Address 6. TYPE of Construction — (Please indicate by X) Ln i.n ( 1 Wood Frame i ) Masonry i 1 Steel I I n 0 ]. PLAN$ and Specifications rr 1000 gallon tank , 250 ft . leach field and #2 stone per plot c No. and application . w C 8, Proposed Use .b Sewage system for dwelling 0 w ct. $ 10 , 00 PERMIT FEE PAID — THIS PERMIT EXPIRES June 11 19 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 Queensbury before the expiration date.) dyyq.. i� Dated at the Town of Queensbury this llth Day of June 19 87 C w SIGNED BYAlz� for the Town of Queensbury N Building and Zoning Inspector 0 ,�Amyown dfacend4or 10 APPLICATION FOR SEPTIC DISPOSAL PERMIT TC VV" GAF QLiE-jgSE,. �t JUN 9 1987 DATE _--- -/ �' BUILDING % CODE DEP`r LOCATION OF PROPERTY FOR INSTALLATION �� L1OCkYt { C[ Lk Owner's Name: V i r1tc Telephone: Address* ,7, C,40 t L" tiJIc2 'o Installer's Name: t pY4V F!:6t1Dra Telephone: ( 'g- � ,3 aLI,5- Number of bedrooms (residential only) _��--- Total daily flow (compute @ 150 gal per bedroom) Topography: circle one: Flat Rolling Steep Slope % of slope Soil Nature: circle one: Sand Loam Clay Other / Depth: �— feet Ground Water: At what depth? feet Bedrock or impervious Material: At what depth? ��1� � feet Percolation test: circle one: not required required / rate in in. inch. Domestic water supply: circle one: Municipal Well Other _ IF domestic water supply is a Well: Separation: Watersupply from Septic absorption _ feet PROPOSED SYSTEM: Septic Tank fir _ gal. (minimum size: 1 ,000 gal.) TILE FIELD * Each Trench ::ta feet / Total system length Q !;:'Q 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 ...Please...LIST NEW EQUIPMENT TO BE INSTALLED (7 t9 C7 A / T C:.es K C,I'- C (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 2.4 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. 1 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: Date: - � Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SE fTLED 1763 . . . HOME OF NATURAL BEAUTY A GOOD PLACE TO LIVE y_ rtl 0WI! Ci� ftFCrI S �Lt BUILDING and ZONING DEPARTMENT Bay and Haviland Road. R, D. 1 Box 98 oueensbury. New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME 1 E Y, C3 rr 4t. r a LOCATION 3 c�. lJl1 1 #' DATE /a /11 _I a ? PERMIT NO. SOIL TYPE - Sand -- Loam - ClaY - Percolation Test Required? YES Percolation rate - Min/Inch _ TYPE of SYSTEM: Absorption field , tonal 1en�th ' Length of each trench �J Depth of trenches - Size of gravel.. SEEPAGE PITS4Nu3nber of) _ Size- ft. X ft. Gravel size PIPING : Size _ Type r G Bldg * to tank PF Tank to dist.' box -...... Disto box to field / _'` y �- openings sealed? ES NO Partial IjOCATION/SEPARATI Foundation to tank © ft. Foundation to absorption =1ft- Absorption to lot line -H ft. Sepamatiopeinj Pits g _of ta yyTl YSTEM ON PROPERTY (circle one) Front "Rear Left side - Right side - CC14MEN SYSTEM usE APPROVE 4XI Bpector 01/86 and vl cop "� r rc.} • Lv'"'�-�� ca act d�C of � !yam.� �4p, �.6'�'+.o .,-�___-�_-�__-_-_, 1 r-o�-� �, n .0 �-i• a � Q 11 L IV � 4 c.. �r�e.-•cG. P� ''Q .N or r V) s." 1 F2c�tdcnCc. ( r'' ! r r f _ I cc \ r r f r r r r � r r r t i r r r L _ - { ' Y o - -` - •- . _ _ ~" =� I ! Cyr-'a F-'r'f-`� 11.1 k{h I d f 4 r-Cs r. 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