1987-828 BUILDING PERMIT
TOWN OF Q►UEENSBURY No. 87-828 �
WARREN COUNTY, NEW YORK o
Wayne Kellogg
PERMISSION is hereby granted to Way .F.
2a North Church Lane
OWNER of property located at r-
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 plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1 . OWNER'S Address is Same
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2. CONTRACTOR or BUI LDERS Name ~
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Sanitary Sewer aq
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3. CONTRACTOR or BUILDERS Address
P . Q . Box 224
Glens Falls , N . Y . 12801
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4. ARCHITECT'S Name
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5. ARCHITECTS Address
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6. TYPE of Construction — (Please indicate by XI
( ) wood Frame I ) Masonry I ) Steel ( }
7, PLANS and Specifications
No. Distribution Box 2 6 ' x 8 ' dry wells ( Existing; 1000 tank) E
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B. Proposed Use
Sewage alteration y>
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1000Q December 8 89 O
$ PERMIT FEE PAID — THIS PERMIT EXPIRES ! 19 0
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this �8th Day of December 1987
SIGNED BY �> - mod for the Town of Queensbury
Building and Zoning Inspector
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APPLICATION FOR 'SEPTIC DISPOSAL PERMIT DEC, 21987
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LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: (-NkA, _ _ / Telephone:
Address: ( ° 1�� 4AC
Installer's Name: , - Telephone:
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one: let Rolling Steep Slope °rI`i of slope
Soil Nature: circle one: and Loam Clay Other j Depth: feet
Ground Water. At what depth? feet
Bedrock or Impervious Material: At what depth? _ feet
Percolation test: circle one: not requiri� required / rate min. inch.
Domestic water supply: circle one: unicipal Well Other _
IF domestic water supply is a Well:
Separatione. Watersupply from Septic absorption _ feet
,c�,-., �JG L 57'1*4(.
PROPOSED SYSTEM.: Septic Tank t tz.�C�_ gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S) : Number of j Size each - 62` feet by 9 feet
Size of stone to be used # _ / Depth or Thickness 2 — feet
*r,:P O R T A N T
...Please...LLST NEW EQUIPMENT TO BE INSTALLED
(over)
Section lI 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 Queensbury Sanit wage Disposal Ordixaaace.
Signature of responsible person:
Date: j pr ']
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12$01
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . A GOOD PLACE TO LIVE
._.Jawn n� �ueen3hesr�r
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISAL SYSTEM TI�SS� ECTION Fj
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LOCATION ✓+' G dI aGG'
DATE ) �'- � PERMIT NO .
SOIL TYPE - Sa d - Loam - Clay -
Percolation Tes Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM :
Absorption field , total le th
Length of each tre ch
Depth of trenches
Size of gravel:_
SEEPAGE P ITS4NurnX, f
Size �Zft. X
Gravel size
PIPING : z l
Bldg * to tank
Tank to list _ box L
Dist . box to fill /pit L '�
Openings sealed? YES N Partial
LOCATTONfSEPARA IONS :
Foundation to k t_
Foundation to bsorption 1
Absorption to lot line A— ft .
Separation of pits *rift.
Ie SYSTEM ON PROPERTY (circle one )
roFENTS'
Rear - Left side - Right side -
:
SYSTEM USE APPROVED
Bux in Inspector
01/86 and vl
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