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1989-135 BUILDING PERMIT TOWN OF QUEENSBURY � No. 8 — ] _; ; 'U WARREN COUNTY, NEW YORK � f PERMISSION is hereby granted to Robert Clyitt hs F � r^� � rn OWNER of property located at '"T Z-r_.3 Luzerne Road Street, Road or Ave. I� i 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 Box # 4 Route 4 cD C 2. CONTRACTOR or BUILDERS Name William Threw 0 0 Cr m 3. CONTRACTOR or BUILDERS Address Iy. 4, ARCHITECT'S Name G N S. ARCHITECT'S Address (D ri �i O 6- TYPE of Construction — (Please indicate by X) iy ( y Wood Frame ( ) Masonry ( I Steel ( } 7. PLANS and Specifications No. 1000 gal . tank , 200 ' the field as per plott plan and application . S. Proposed Use rn Sewage AlterationkJQ rn $ 25 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES Apri1 4 (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the (D town of Queensbury before the expiration date.) Qu F'- O Dated at the Town of Queensbury this 4/g��hDay of �,r i 1, 19 >� �a � SIGNED 13Y }�,�,,z _ � �! for the Town of Queensbury Building and Zoning I rgwctor TOWN OF QUEENS.P URY Town1 OF ouEENsauRY APPLICATION FOR RECEIVED �> SEPTIC DISPOSAL PERMIT '� MAR 3 4 1989 BLDG. & CODE DEPT. DATE SPY Li LOCATION OF PROPERTY FOR INSTALLATION f� Z bZ A" `��• Owner's Name: r-�',r1�" ��ti��e�.. ./ Telephone: ✓2 9 3 .. C2 Address: 00 Installer's Name: Telephone: Number of bedrooms (residential only) Total daily flow (compute (d 1 So. gal per bedroom) i .J Q Topography: Circle one: lot Rolling Steep Slope % of Slope Soil Nature: Circle onesle) Loam Clay Other /Depth: Feet Ground Water: At what depth? / f Feet Bedrock or Impervious Material: At what depth? Feet Percolation test: Circle on not require required rate min. inch. Domestic water supply: circle one: unicipa Well Other fi If domestic water supply is a wel . 14 Separation: Water supply from septic absorption r. feet PROPOSED SYSTEM: Septic Tank 1600 gal. (minimum size: 1 ,000 gal.)..G TILE FIELD: Each Trench r...' Q feet/Total system length • C 'i feet SEEPAGE ee Size of stone to be used #.,I ,/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 Rueensbury Sanitary Sewa isposal rdinance. SIGNATURE OF RESPONSIBLE PERSON: DATE : " ,� I OVER ._.I'own 01 Queenshury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Oueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION AM NE _ E l__ 0 T tvi 17 i-1* ©—erS+�L� LOCATION DATE �� PERMIT NO . t SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate _ Min/Inch TYPE of -SYSTEM: AbsorpticIp field , total length Zo " Length of `elach trench SQ Depth of trkknches Size of gravA}_ 'Z� SEE PITS4 er of S a. Gravel size PIPING : Size 1' Type Bldg . to tank Tank to dist . box Dist_ box to field/pit Openings sealed? YES NO Partial F LOCATION/SEPARATIONS : �. Foundation to tank P ft. Foundation to absorpieion ft . Absorption to lot 1Yne ft . Separation of Pits LOCATION Off' SYST7 ON PRGPERTY [ ' rcle one Front - Rear - L ft side - Right ide COMMENTS : 00 SYSTEM USE APPROVEID4ZY�IEIOON Building tor 01/86 and Vl 4 4 Ol {j i Mal 09 r t {d b r 5 ti )e;D .