1987-714 BUILDING PERMIT �
TOWN OF QUEENSBURY No 87- 714 �
WARREN COUNTY, NEW YOR K =�
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PERMISSION is hereby granted to IrTorthwi nds Trailer Park
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OWNER of property located at ktAv Luxerne Rd . Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Sewage Alterations
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.
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1 . OWNER'S Address is Same o
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2. CONTRACTOR or BUI LDER S Name M
Dan Drelliss w
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3_ CONTRACTOR or BUILDER'S Address
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d. ARCHITECT'S Name
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5. ARCHITECT'S Address N
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6, TYPE of Construction — [Please indicate by x) "
l 1 Wood Frame i ) Masonry i 1 Steel l i
7. PLANS and Specifications
No. Master Application for Septic Systems
8, Proposed Use (D
Hewage Alterations w
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Oct . 26 , 19 ^89 �
$ 80000 PERMIT FEE PAID — THIS PERMIT 'EXPIRES s0
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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 N,
town of Gueensbury before the expiration dateJ o
Dated at the Town of Queensbury this ��•• 26th Day of October 19 87
SIGNED BY / ' �`- � for the Town of Queensbury
Building and Zoning Inspector
APPLICATION FOR SEPTIC DISPOSAL PERMITS UU , f LU0CT 2 31'987'
DATE U ! l
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: /�" 1� Pr �G"' �° /! <•-r— a f/U+'/ G'r7// iC'J
Address: ( �'^ C7 /r9�r°7�i � d? �
Installer's Name: � ' � _ Telephone:
Number of bedrooms (residential only)
Total daily flow (compute (,W 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
BeKlrock or Impervious Material: At what depth? feet
Percolation test: circle one: not required required / rate min. inch,
Domestic water supply: circle one: Municipal Well Other
IF domestic water supply is a Weil:
Separation: Watersupply from Septic absorption _ feet
PROPOSED SYSTEM: Septic Tank . gal. (minimum size: 1 ,000 ,gal.)
TILE FIELD: Each Tre t / T a system length
SEEPAG IT(S) : Number of / Size each feet by feet
Size of stun ee
IMPORTANT
...Please...LIST NEW E+QtHPMENT TO BE INSTALLED
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Section Il 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, 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.
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.
1 have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbur-y Sanitary Sewage EKsposal Ordinance.
Signature of responsible person:
Date:
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 742-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . A GOOD. PLACE TO LIVE
_lawn n� �irreenslsur�
BUILDING and ZONING DEPARTMENT
Bay and Haviiand Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME `
LOCATION-
DATE 9ERMIT NO.
Soil, TYPE Sa - Loam - Clay -
Percolation Test Required? YES
Percolation rate •- Min/Inch Cf) `, j
TYPE of SYSTEM:
Absorption field , total length
Length of each trench
Depth of trenches '
Size of gravel_
SEEPAGE PITS{Nuinber of)
Size- Jcz�ft. X _ fto
Gravel size d ►�c. -y-r_
PIPING : ize Type
Bldg . to tank _
Tank to dist. box
Dist. box to field
ES NO openings sealed? Partial
LOCATION/SEPARATIONS :
Foundation to tanklft.
Foundation to absorption t ,
Absorption to lot line ft.
Separation of pits ft.
LOCATIONSYS!eEMf
ON PROPERTY 'circle one)
Front - side - Right side
CCP94ENT
A
SYSTEM USE APPROVE YE NO
Building Inspector
01/86 and vl
flown a/ Quee4n '51"r y
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Queensbury, New York 12801
SEPTTIICC DIS OSAL SYSTEM INSPECTION
AM NE �;x 4ej !•
LOCATION /W 7
DATE �! � 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 to
Gravel size -
PIPING : S 3.zq Type
Bldg . to tank
Tank to dtst. box
FOA
Dist. box to fiel
Openings sealed? YES NO Partial
LOCATXON/SEPARATIONS :
Foundation to tank t.
Foundation to absorption to
Absorption to lot line ,.L._
Separation of pits
LOCATICI1 OF SYS PE circle ne)
Front - Rear - ft aid - Righ side -
CC HMENTS :
- �
M 701
SYSTEM USE APPROVE YE NO
Bulldlncf Inspector
01/86 and vl