1987-723 BUILDING PERMIT �
TOWN OF QUEENSBURY �
No. 87-723 z
WARREN COUNTY, NEW YCIRK
PERMISSION is hereby granted to Montcalm Restaurant w
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OWNER of property located a 4f 5 Route 4 Street, Road or Ave. Un
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 Same
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2. CONTRACTOR or BUI LDE R'S Name
Sanitary Sewer m
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3. CONTRACTOR or BUILDER'S Address 1"
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P . O . box 224 w
Glens Falls , N . Y . 12801 r�r
d. ARCHITECT'S Name
5_ ARCHITECT'S Address
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6. TYPE of Construction — (Please indicate by x)
( ) Wood Frame { ) Masonry { ) Steel { i
7• PLANS and Specifications
No_ 1000 gal grease tank, #4 Distribution box , 1500 ' leach xxxxx m
field as per plot plan and application .
8. Proposed Use m
Sewage Alteration
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10 . 00 Oct . 89 0
$ PERMIT FEE PAIL} — THIS PERMIT EXPIRES 27 ' i9
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Gueensbury before the expiration date_)
Dated at the Town of Queensbury this 27th Day of October 79 87
SIGNED BY for the Town of Queensbury
�. Building and Zoning Inspector
APPLICATION FOR SEPTIC DISPOSAL PERMIT
OCT 21 1987
DATE 1 �r' E: .), ,j / 0� e
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: PI. 4E? S I Telephone:
�Address: J U 140
Installer's Name: . / �t 'Telephone: pR r { {
Number of bedrooms (residential only) �—
Total daily flow (compute @ 150 gal per bedroom )
Topography: circle one: Fla Rolling Steep Slope % of slope
Sail Nature: circle one. an oam Clay Other / Depth: — feet
Ground Water: At what depth? feet
Bedrock or Impervious Material.: At what depth? i r feet
Percolation test: circle one not required equired / rate min. inch.
Domestic water supply: circle one Municipal ell Other _
IF domestic water supply is a Well:
Separation: Watersupply from Septic ahsor d ption _ -~�` feet
PROPOSED SYSTEM: Septic Tank � � gal(e (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length 0 feet
SEEPAGE PIT(S) ; Number of / Size each feet by feet
Size of stone to be used # N�2 / Depth or Thickness _ r feet
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
IMPORTANT
...Please...L.IST NEW EQUIPMENT TO BE INSTALLED
No
(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 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
Be 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 arwee to abide by these all requirements
of the Town of Queensbury Sanit W Disposal ord" cea 71
71
Signature of resp nsible person:
Date.
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTLE [) 1763 . . . HOME OF NATURAL, BEAUTY . . . A GOOD PLACE TO LIVE
�?O.n of 'Queerviledry
BUILDING and ZONING DEPARTMENT
Say and Haviland Road, R.D. 1 Sox 98
pueensbury. New York 12801
SEPTIC D1SP9SAL0SYSTEM I1Y PECTI
NAME
44
LOCAT ION I
� � y
DATE
f �I 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 PITS4NW11ber of)
Size- ft. x - ft .
Gravel size Siz Type
PIPING :
Bldg * to tank
Tank to list . box
Dist. box to field/p i !'!J
openings sealed? ES P10 Partial
LOCATION/SEPARATIONS : ft.
Foundation to tank ft .
Foundation to absorption ft .
Absorption to lot line ft.
Separation of pits
LOCATION op' SYSTEM CN PROPERTY (circle one)
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Front - Rear eft side fight side -
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CMENTS : � (t fly
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SYSTEM USE APPRQVELI 4'0
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Lau i 1 1 Inspector
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