1989-169 BUILDING PERMIT
TOWN OF QUEENSBURY 01
No. s$�64 � �
WARREN COUNTY, NEW YORKlow
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PERMISSION is hereby granted to Richard Fallon IS
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OWNER of property located at 6#1 Revere Road Street, Road or Ave. 1
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in the Town of Oueensbury, To Construct or place a Sewage Alteration
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance-
1 . OWNE R'S Address is
Same
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2_ CONTRACTOR or BUILDER 'S Name
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Chris Crandall
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3. CONTRACTOR or BUILDER 'S Address n
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4. ARCHITECT'S Name
S. ARCHITECT'S Address
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6. TYPE of Construction — (Please indicate by XI
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11 Wood Frame I I Masonry ( ] Steel i 1 M
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7. PLANS and Specifications W
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No. 1000 gal . existing tank , 2500 rile field as per plot pls
and application
8, Proposed Use
Sewage Alteration
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$ 25000 ____ PERMIT FEE PAID — THIS PERMIT EXPIRES RNMEA April 13 1g 91 ac
(If a longer per is re u!red an a Iication for an extension must be made to the RuIIdi 9 l'� 4 e e rg and Zoning inspegtor of the f17
town of Queensbury before the expiration date.)
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Dated at the Town of Queensbury this lath Day of A 1l 19 89
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SIGNED BY for the Town of Queensbury N
Building Zoning lnspect r O
1 o tiv�v ar Q UEENSB UR Y
APPLICATION FOR. TOWN OF QUEENSBURY
r RECEIVED
SEPTIC DISPOSAL PERMIT
APR 1 2 19F9
BLDG. & CODE DEPT,
DATE ! �/
LOCATION OF PROPERTY FOR INSTALLATION �e' 00, e✓fe'. kL
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Owner's Name: "%',e / /""rC ` C Ce7- �� Telephones ./ ' . .', �_ ��/ : e /
Address:
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InstallerTs Name: Telephone. ` r
Number of bedrooms (residential only)
-7'
Total daily flow (compute (d 150 gal per bedroom) gf!('�C% _
Topography: Circle one 'F'lat�Rolling Steep Slope % of Slope
Soil Nature: Circle on , Sand oam Clay Other /depth : Feet
Ground Water: At what depth? (.fA_ L; _,�,,,I Feet
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle one: (not require required rate min, inch.
Domestic water supply: circle one: unicipa Well Other
If domestic water supply is a well .
Separation : Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank r[`✓_ %!" gal. (minimum size : 1 , 000 gal.) ,e74"% .
TILE FIELD : Each Trench _''! >feet/Total system length t_ ; �!TJ feet
SEEPAGE PIT(S): Number of / Size each feet by ! feet
Size of stone to be used #Depth or Thickness 4 ;o , � � ' " _ 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,
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SIGNATURE OF RESPONSIBLE PERSON:
DATE: o / r ' — f''
OVER
Queen3Esctr�r
BUILDING and ZONING DEPARTMENT
Bay and Haviiand Road, R,C1, 1 Box gg
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION 'i 3 'P }Q
DATE j PERMIT NO. !' J �
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation Irate - Min/Inch
TYPE of SYSTEM:
Absorption fie�d , total length 2'
Length of eachrench ��
Depth of trenched LI
Size of gravel
SEEPAGE PITS{NtunbeA of)
Size- ft. X _ 1ft,
Gravel size �`�
PIPING :
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Bldg6 to tank T / /
Tank to list. box v HE
Dist. box to field/ ' t
Openings sealed? Es NO Partial
LOCATION/SEPARATIONS:
Foundation to tapic / rr ft.
Foundation to adsorption ft
Absorption to ,lot line ft_
Sep tion of pits -- ft.
I N OF YSTEM ON PROPERTY (circle one)
ront Rea - Left side - Right side -
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SYSTEM USE APPROVED YE I NO
Bu • ng In
01/86 and V1
TOE � OF QUEHNIUR
S � Y TOWN OF QUEENSBURY
BUILDING "' ES DEPT.
REVIEWED 8y Zoning Ad istrapt
DATE
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503
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