1987-458 BUILDING PERMIT �
TOWN 4F QUEENSBURY No. 87_458
+{+ WARREN COUNiTY, NEW PORK o
2,( Ab . 1. rl3l Y.
PERMISSION is hereby granted to George Finch o
1
OWNER of property located at Luzerne Rd , & Newcomb 2 N wcc( , 1n_ Street, Road or Ave_
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.
t. OWNER'S address is Luzerne Rd . & Newcomb
Queensbury , N Y 12801
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2. CONTRACTOR or BUI LDE R'S Name aq
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Queensbury Sewer Service �y
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3. CONTRACTOR or BUI LDE R'S Address
RD ## 1 Upper Bay Rd .
Lake George , N . Y . 12845
4. ARCHITECT'S Name r
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S. ARCHITECT'S Address
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S. TYPE of Construction — [Please indicate by X) ro
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{ ) wood Frame 1 ) Masonry ( ) Steel f 1
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7. PLANS and Specifications
No_ 1000 gal tank 2 seepage pits 4 ' x 6 ' each as per plot plan and
application .
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8. Proposed Use f°
Sewage alteration a4
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$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES July 1+60, 19 89 w
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(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the o
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 16th Day of July {9 87
SIGNED BY �t'" for the Town of Queensbury
Building and Zoning Inspector
} APPLICATION FOR SEPTIC DISPOSAL PERMIT r- Ttj�fr* C7�
Apr
DATE
40
LOCATION OF PROPERTY FOR INS ELATION
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Owner's Narn ���� f C. Telephone:
Address: d
a e, [ CJ
Installer's Name: Telephone:
Number of bedrooms (residential only) Z
Total daily flow (compute @ 150 gal per bedroom ) z�Z1
Tapagraphy: circle one: 4K,
Rolling Steep Slope of slope
Soil Nature: circle one: Sand Darn Clay Other / Depth: feet
Ground Water: At what depth? feet
'rock or Impervious Material: At what depth? _ feet
Percolation test: circle one• sat er quired required / rate ruin. inch.
Domestic water supply: circle on Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption i feet
PROPOSED SYSTEM : Septic Tank/./ s � gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S) : Number of / Size each feet by feet
Size of stone to be used # _ / Depth or Thickness 12 feet
I M P O R T A N T
Please...LIST NEW EQUIPMENT TO BE INSTALLED
(over)
BUILDING and ZONING DEPARTMENT
Bay and Hauiland Road, R. D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION Gam/ y p
DATE ",,00P r PERMIT NO ,
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch _
TYPE of SYSTEM:
Absorption field , total length
Length of each trench
Depth of trenches
Size of gravel
SEEPAGE PITS4Number of)
Size_ ./ ft&)x
Gravel size -
PIPING : Size Type
Bldg * to tank P --
Tank to disc_ box _ '
Dist . box to field/ `r /c
Openings sealed? Y NO Partial
LOCATION/,.SEPARATIONS : /
Foundation to tank ft-
Foundation to absorption o;� f t. 2-�
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Absorption to lot line Str��) ft. /S
Separation of pits / fto
LOCATION OF SYSTEM ON PROPERTY (Circle one)
Front Re r Right side -
COMMENTS :
SYSTEMS USE APPRQvl YES NO
Build ' g Inspector
01/86 and vl
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