1987-829 BUILDING PERMIT �
TOWN OF QrUEENSBURY No. S7-829 �
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WARREN COUNTY, NEW YORK
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55 c+
PERMISSION is hereby granted to James De Santa'_
10 Westland
OWNER of property located at Street, Road or Ave.
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in the Town of Queensbury, To Constructor 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 BUILDER'S Name m
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Queensbury Sewer Service �
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3_ CONTRACTOR or BUILDER 'S Address
Jay Sweet
RD 1 Upper Bay Rd .
Lake George , N . Y . 12845
4. ARCHITECT'S Name p
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5. ARCHITECVS Address W
6. TYPE of Construction — (Please indicate by X)
l 1 Wood Frame ( 1 Masonry ( 1 Steel ( }
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7. PLANS and Specifications
Distribution Box 180 ' of leach fields a°
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No.
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8. Proposed Use ro
Sewage Alteration
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$ 10 . 00 PERMIT FEE PAID - THIS PERMIT EXPIRES Dec . 8 1989
ilf a longer period is required an application for an extensian must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.l
Dated at the Town of Queensbury this 8th Day of Dec . 19 87
SIGNED BY for the Town of Queensbury
Bui ding and Zoning Inspector ,,J�,,� .
C7V4 {V OF ' UU -.
APPLICATION FOR SEPTIC DISPOSAL PERI '��
n iF r 1987 v'
l DATE 'C. �F�i�T
4 LOCATION OF PROPERTY FOR IN ALLATION
Owner's Name: C zZ �C 121<Co ter; Telephone:
Address:
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Installer's Name: P e & S G-c-.� , ' fr' x'-✓" Telephone:
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one: Flat Rolling Steep Slope 3& of slope ,
Soil Nature: circle one: and Loam Clay Other / Depth: feet
Ground Water: At what depth? feet
Bedrock, or Impervious Material: At what depth? feet
Percolation test: circle on not regq" irre_ ..a required / rate min. inch.
Domestic water supply: circle oneiunic Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM: Septic Tank .mac" ?J_ gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench a 0 feet f Total system length XS�r) feet
SEEPAGE PIT(S) : Number of / Size each feet by feet
Size of stone to be used # / Depth or Thickness / rr feet
IMPORTANT
...Please...LIST NEW EQUIPMENT TO BE INSTALLED
(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
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.
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 agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage Disposal C kdinance.
Signature of responsible person:
Date: 2 - "
or
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . A GOOD. PLACE TO LIVE
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