1987-785 BUILDING PERMIT A2
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TOWN OF +QUEENSBURY g7- ,$s i5
,, WARREN COUNTY, NEW YORK No 0
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PERMISSION is hereby granted to Wilfred Pouliotte n
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OWNER of property located at k � Luzerne Rd , v,e ,
Street, Road or Ave, r.3
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 Queenshury Building and Zoning Ordinance.
t. OWNER'S Address is
Same
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2. CONTRACTOR or 6Ul LDER'S Name
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Sill Threw Inc .
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3. CONTRACTOR or BUILDER 'S Address
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4. ARCHITECT`S Name
5. ARCHITECT'S Address C
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B. TYPE of Construction — (Please Indicate by X)
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{ } Wood Frame ; I Masonry ; ) Steel ; 1 92
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F7PS and Specifications
No. Repair work as er lotP p plan and application .sed Use
Sewage Alterations
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10000 ro
PERMIT FEE PAID — THIS PERMIT EXPIRES November 24 11989 y
If a longer period is required an application for an
to extension must be made to the Building and Zoning inspector of the 'rt
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town of Queenstw before the expiration date.) ro
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Dated at the Town of Queensbury this 24th Day of November 19 87
SIGNED BY _ 6x / — '_ for the Town of Queensbury
Building and Zoning Inspector
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APPLICAT70M FOR SEP'ITC DISPOS}AL PERMIT �? � � �i i � t, � V
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ILDING
DATE
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: . Tf/ ra r1 Telephone: �� 72- Z `
Address:
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Installer's Name: yr, ?_=geL:. 4 A / Telephone: 7 �z'
Number of bedrooms (residential only)
Total daily flow (compute CO) 150 gal per bedroom) —L 5: C_3
Tbpcggraphy: circle onev.j la Rolling Steep Slope 90 of slope
Soil Nature: circle one: an Loam Clay Other / Depth: _ feet
Ground Water: At what depth? 'c feet
Bedrock or Impervious Material: At what depth? _ feet
Percolation test: circle one: not required required / rate min. inch.
Domestic water supply: circle one unicipal Well 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 t
SEEPAGE PIT(S) : Number of � /� / Size each feet by feet
Size of stone to be used # _ / Depth or Thickness � feet
IMPORTANT
...Please...LIST NEW EQUIPMENT TO BE INSTALLED
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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
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 $25O.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 roegulations above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage Ddapcoal Clydiwance.
Signature of responsible person:
Date:
Town of Queensbury
Building. and Code Department
Bay at Haviland Road
Queensbury, New York 1Z8O1
(518) 79Z-5832
SE fTLED 1763 HOME OF NATURAL BEAUTY A GOOD- PLACE TO LIVE
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BUIL01NG and ZONING DEPARTMENT
Bay and Ha► iland Road, R-D. I Box 98
Oueensbury, New York 12801
SEPTIC DISPO SYSTEM INSPECTION
NAME of .
LOCAT ION 1 +I W 4e s4 Z
DATE l / PERMIT NO, 0 /
SOIL TYPE - sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption fi d , total length
Length of eac txench
Depth of trenc es
Size of gravel_
SEEPAGE PITS{N ex of)
Size- �ft. X 0 ft ,
Gravel size
PIPING : A
Size Type
Bldg , to t
Tank to li
Dist . box td/pi
Openings seYE NO Partial
LOCATION/SEONS ,Foundation k t�,Foundation do ft.JAbsorption ine ft.Separation s ft,LOCATION ON PROPE Y (c0 1 vne )
Front - Reat side - Ra ht sideCCMMENT •
SYSTEM USE APPROVED YES O
Building nspector
01/86 and vl
_Down a/ Q14een3 ury
BUILDING and ZONING DEPARTMENT
k Bay and Hauiland Road, R.D. I Box 98
Queensbury, New York 12801
7-2z.
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION D496IM66 'V
DATE / 1,1 _Z PERMIT NO.� b
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SOIL TYPE - an - Loam - Clay -
Percolation st Required? YES - O
Percolation rate - Min/Inch -
TYPE of Sy TEM:
Absorpti field otal length
Length of ea each
Depth of tr he
size of g ve
SEEPAGE PITS-EN ex- of _
Size- -A -�r ft- R ft .
Gravel size jv� +
PIPING : Size Type
Bldg . to tank "eve "
or
Tank to crr �'
fiel / t
„,...-Openings sealed? Y NO Partial
L OCATION/SEPA IONS
Foundation to ank z �f t.
Foundation t absorption 6Oft .�F
Absorption lot line ft- 2
Separation f Pits ft•
LOCATION O SYSTEM ON PROP TY (circle one)
Front - - Left side - Right side -
CCKMENT
SYSTEM USE APPROVE YE O
Building Inspector
01/86 and V1
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