1987-438 BUILDING PERMIT
TOWN OF QUEENSBURY No.
87_438 �
WARREN COUNTY, NEW YORK
PERMISSION+ is hereby granted to Robert Folley
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OWNER of property located at rj Sunset Trail Street, Road or Ave_
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in the Town of Ousensbury, 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 . OWNE R"S Address is
Sunset Trail
Queensbury , N . Y . 12801
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2. CONTRACTOR or BUI LDEWS Name ro
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Sanitary Sewers
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3. CONTRACTOR or BUILDERS Address h-+
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P . O . Box 224
Glens Falls , N . Y . 12801
4. ARCHITECT'S Name
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5. ARCHITECT'S Address y
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6. TYPE of Construction — (Please indicate by X)
C 1 wood Frame { ) Masonry { ) Steel { 1
7. PLANS and Specifications
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No 4 8 ' x4 ' pre-cast dry wells Distribution Box �
Per plot plan and application
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8_ Proposed Use �.
Sewage A,lterati on
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$ 10 , 00 PERMIT FEE PAID - THIS PERMIT EXPIRES July 10 $ 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_)
Dated at the Town of Queensbury this 10 Day of July19 87
SIGNED BY /.� /_ �:z�� for the Town of Queensbury
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Building and Zonirg Inspector ,sC/, �_
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�j APPLICA17ON FOR SEPTIC DISPOSAL, PERMIT ALL � �'
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SurLUU & CODE DEPT.
DATE ✓ 'C.f �tU�� /
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: �� ! i V Telephone:
Address: �I t,r' A-) .3 k� -2� 72rzA- Z
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Installer's Name: � /V y+ �T �iC z' Telephone:
Number of bedrooms (residential only) ? _
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one: la Rolling Steep Slope % of slope
Scan Nature: circle one: wand Loam Clay dozer / Depth: feet
Ground Water: At what depth? feet
Bedrock or Impervious Material: At what depth? i � '"� feet
Percolation test: circle one: not required required / rate min. inch.
Domestic water supply: circle one Wel 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 feet / Total system length feet
SEEPAGE PIT(S) : Number of { Size each Z `'i feet by feet
Size of stone to be used # 3 Depth or Thickness ,...--- feet
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IMPORTANT
...Please.**LIST NEW EQUIPMENT 71`0 BE INSTALLED
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Section 1I Septic System Inspections:
A. All applications for septic system installation, alteration or repair, as
required by the Town of Queensburyy 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.
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 neg lations above and aswetsto abide by these and all requirements
of the Town of Queensbury SanitaTwage)D�- :tO d
Signature of r onsible person:
Date:
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York I2801
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . A GOOD PLACE TO LIVE
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i195 BUDDING andlFZONING DEPARTMENT
Say and Havifand Road, R- D• i Box 98
oueensbury. New York 12801
1 � SEPTIC DISPOSAL SYSTEM INSPECTION
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LOCATION
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17A'SE PERMIT NO .
SCIL 'TYPE - Sand. - Loam - clay -
Percolation Test Required? YES - NO
percolation rate - min/inch
TYPE of SYSTEM: total length
Absorption field .
Length of each trench
Depth of trenches
Size of grave3
SEEPAGE P ITS- UI- ber Of) Je
Size-
Gravel size ` D
PIPING % SIZ7 Type
Bldg . to tank SG h' 'v
Tank to list . box k
'Dist. box to fW/ partial
openings sealed? YES NO
LOCATION/SEPARATIONS :
Foundation to tank /.gift' j-
Foundation to absorption if t •.. '
Absorption to tat line
Separation of pits � ^ft.
1 OF SYSTEM ON PROPERTY (circle one]
runt -
ear - Left side - Right side
ENTS :
SYSTEM uSE APPROVED YES NO
Boil ing Inspector
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