1989-110 BUILDING PERMIT
TOWN OF QUEENSBURY No 89 - 110 �
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Mattliias Greene cz)
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OWNER of property located at Street, Road or Ave. 1
in the Town of Queensbury, To Construct or place a S a gf� "I 9- era t i on
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
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Same
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2. CONTRACTOR or BUI LDE R'S Name :IM
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Self rim
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3. CONTRACTOR or BUILDER'S Address m
Same
4. ARCHITECT'S Name t3i
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5. ARCHITECT'S Address o
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6. TYPE of Construction — (Please indicate by X)
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{ ) Wood Frame I ) Masonry 1 I Steel ? O�
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7. PLANS and Specifications 0
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No. loon gal . tank , 135 ' of -tile field as per plot- plan , ::V
and appliCatiOn .
S. Proposed Use
Sewage Alteration
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PERMIT FEE PAID - THIS PERMIT EXPIRES March 27 19 91 m
$ 25 (] C z
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of Atha �
town of Queensbury before the expiration date.) @
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Dated at the Town of Queensbury 2 7 Ala Day of Maw C11 19 39
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SIGNED BY for the Town of Queensbury
Building and Zoni Inspector C
TOWN OF ,Qur- r�NSBL1rY � v- I - yj
APPLICATION FOR
,- }= f4N OF QUEENSBURY
SEPTIC DISPOSAL PERMITRECEIVED
MAR 2 31989
BLDG. & CODE DEPT.
DATE ,�--�.� _ � . 9
LOCATION OF PROPERTY FOR INSTALLATION _ � K rr � _ Sri Sf. a/ Al-
Owner's Name: A2 j� t /0 r- en � T Telephone:
Address:-4 „ I 6c) x 2 n F. n�v3 rrxe f/
InstaIler's Name: �/� rE �. � e Telephone :
Number of bedrooms (residential only) 2_
Total daily flow (compute (8 150 gal per Bedroom)
Topography: Circle one: d5;7P Rolling Steep Slope of Slope
Soil Nature: Circle one: 43� Loam Clay Other /Depth: Feet
Ground Water: At what depth? Feet
Bedrock or Impervious Material: At what depth ? Feet
Percolation test: Circle one: not required required rate min. inch.
Domestic water supply. circle one: Municipal CWeh .. Other
If domestic water supply is a well;
Separation: Water supply from septic absorption Oe0 Sj feet
PROPOSED SYSTEM : Septic Tank gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet/Total system length Z3 5 feet
SEEPAGE SEEPAGE PIT(S): Number of / Size each feet by feet
Size of stone to be used # s2./Depth or Thickness _ feet
I have read the regulation on the reverse side of this sheet and agree to abide by these
and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
DATE: ;
OVER
Septic System Inspections :
A , .t11 applications for septic system Installation , alteration or repair ,
a required 17y the Town of Queensbury Sanitary :Sewage Ord inatice , shall
t ti �;ubtniccod to the Auilding Dep.trt:uent at least 24 hours before start
of construction and sll ,ill include a 1} lot plan showing :
1 . ) Elie proposed location of the system
2 . ) location and distance to lot. lines
3 . ) location and distance to structures
4 . ) locati.oa and distance to any water supply
S . ) size and dimznsians of all tanks , distribution bozos ,
rile fields and /err drywells
fi Nu !; ysteru stYal.l be coverod before inspection and approval by the
liuild :ing lsaspector . Failure to comply with this requirement may
- � 5ult in the uncovering; of the systeF» by Cite installer and a fine
" I, «p to 1: 2150 . 00 .
C . An eipproved copy of the plot plan shall be available on Elie construction
sites , Failure to produce said plot plan at time of inspection may
fusulc in an immediate work stoppage .
D . Should unforeseen probluws during construction prevent proper installa—
Eiun , alteration or r421,air of an approved system , a new proposal must
10c -; ubmitted to the Queunsbury Building Department before furrijor
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Town of Queensbury
BUILDING and CODE'" DEPARTMENT
Bay and llaviland Roads
Queensbury , New yori: 12804
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BUILDING and ZONING DEPARTMENT
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Bay and Haviland Road, R.D. i Box 98
Queensbury, New York 12801
SEPTIC aDISPOSAL SYSTEM INSPECTION
NAME
LOCAT I OIV '
DATE ._��_ 1_ PERMIT NO . ( rC.)
SOIL 'TYPE - an ' l-roam - Clay -
Percolatl a Required? YES - NO
Percolati6i' , rate - Min/Inch _
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TYPE of SYS%
Absorption f eld , total length /5-Q
Length of eac trench ��o
Depth of tren es - 3
Size of gravel
SEEPAGE PITS4N or of)
Size- ft. X } f `
Gravel. size '
PIPING : Size Type
Bldg . to tank
Tank to dist . box ,,
Dist* box to f d/git
Openings Seale eS IBC) Partial
LOCATION/SEP TIONS *
Foundation tank OL) ft.
Foundation o absorption r rY ft.
Absorptio to lot line �ft-
Separati of pits
LOCATION OF SYSTEM ON PROPERTY ( circle one)
Front - ar Deft side - Right side
CCMMEN .-- '
SYSTEM USE APPROVED YES f10
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Bui ding Inspector
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Date
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