1987-577 BUILDING PERMIT �
TOWN OF QUEENSBURY No 87-577 �
a WARREN COUNTY, NEW YORK o
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PERMISSION is hereby granted to Richard Horowitz
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OWNER of property located at 4 Gilmore Ave . 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 plat plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance_
1 . l:3WNER"S Address is n
4 Gilmore Ave .
Queensbury , N . Y . 12801 "tQ
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2_ CONTRACTOR or BUILDER'S Name a
Sanitary Sewer N.
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3. CONTRACTOR or BUILDERS Address
Sox 224
Glens Falls , N . Y . 12801
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction — (Please indicate by X)
( ) Wood Frame I ) Masonry i ) steel I 1
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7. PLANS and Specifications �
No 1000 gal septic tank & 6 ' x 8 ' dry well for wahser & kitchen sink
only as per plot plan and application . f9
8. Proposed Use r
Sewage alteration to one-family ,t
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$ #R:490 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES August 27 19 89
(If a longer period is required an application for an extension must be matte to the BuilldIng and Zoning inspector of the
town of Queensbury before the expiration date.!
Dated at the Town of Queensbury this 27th Day of August 19 87
SIGNED BYr GC - � for the Town of Queensbury
Building and Zoning I nspector ��/
APPLICATION FOR SEPTIC DISPOSAL PERMIT 1
AUG 2d v
DATE — not - ! *�r7
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Names . C Ll A&j tj0R &j / 2]2 _ Telephone: — 4 a
Address f �- i^ 1 it
Installer's Name: fi+tN fir ■ tj � rr , �„_ Telephone:
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one: Flat Rolling Steep Slope °To 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? _ ---- feet
Percolation test: circle ones of require required / rate min. 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 400 %:7 gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / "Total system length .__ feet
SEEPAGE PIT(S) s Number of / Size each (,w feet by _ feet
Size of stone to be used # / Depth or Thickness Z- feet
I M P O R T A N T
...Please...LIST NEW EQUIPMENT TO BE INSTALLED
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✓ (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 Z4 hours before start
of construction and shall include a plot plan showing:
l .) the proposed location of the system
Z.) 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 $Z50.00.
Co 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 agree to abide by these and all requirements
of the Town of Queensbury Sanit age Mspotsa Ord'
Signature of responsible person:
Date: -- � eP2
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 79Z-583Z
SE -fTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE
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BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPE TION
NAME !2d ! iz- - s
LOCATIONy!
DATE Z 07, PERMIT NQ S"7 -�7
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 PITS{Number of)
Size- ? ft. X ft . -
Gravel size
PIPING : Sit Type
Bldg . to tank �jj Cx
Tank to list. box _
Dist. box to field/ G - s
Openings sealed? IYEs NO Partial
LOCATION/SEPARATIONS :
Foundation to tank Li:Lft.
Foundation to absorption 2 L ft_
Absorption to lot line ft .
Separation of pits ft.
OF SYSTEM ON PROPERTY (circle one )
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Rear - Left side - Right side
SYSTEM USE APPROVE YES NO
Build Inspector
01/86 and vl
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