1989-198 BUILDING PERMIT �
TOWN OF +QUEENSBURY No 89 -198
WARREN COUNTY, NEW YORK
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PE R M I SSIO N is hereby granted to hr
I
LANE Street, Road or Ave.
OWNER of property located at _ ,..� �ta[na�'AIH VLE1� — �
in the Town of Queensbury, To Construct or place a _ SFGTAGE 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.
F2CONTRACTOR
WNER'S Address isSAME or BUl LDEWS Name C
CONDON ' S SEPTIC & DRAIN
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name C
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5. ARCHITECT'S Address
FTYPEE uction — (Please indicate by XI
od Frame I ) Masonry I iSteel 1cifications
1000 gal (existing, tank , HN.gXBtRX 200 feet file fie'per plot plan and application .posed Use
S ,WAGE ALTERATION
Apr31 17 19 91.
$ _ 25 (}0 PERMIT FEE PA10 — THIS PERMIT EXPIRES ,
(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 17tk� Day of Apr
89
il 19
for the Town of Queensbury
SIGNED BY
Building and Zani n,spe ctor
TOWN OF QUEENSB LIRY
APPLICATION FOR OF [ tEENSSUR,Y
SEPTIC DISPOSAL PERMIT Of OVV14CODES �yfip"[ .
DATE 1 -7 -
LOCATION OF PROPERTY FOR INSTALLATION HW►.rfAry �t
Owner's Name: ZAAJ XYWr L, Telephone: 2�' 3
Address: V l
Installer's Name: i Fl 7�[ 1 5 �E7-�t C-'� ir I Telephone:
Number of bedrooms (residential only)
Total daily flow (compute (d 150 gal per bedroom).! +
Topography: Circle tine: Flat Rolling Steep Slope 9G of Slope
Soil Nature: Circle one: and Loa,ern/ ,Clay Other /Depths Feet
Ground Water: At what depth? Ls/,�Q Feet
Bedrock or Impervious Material: At what depth? A)1,4 �Feet
Percolation test: Circle one; not required required rate min. inch.
Domestic water supply: circle one: ldmgunicipal Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorDtion feet
�r'1C( .J'7� t 1'l,lC3
PROPOSED SYSTEM : Septic Ta�nk f 000 gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench r feet/Total system length =.� Q O feet
9, 1
SEEPAGE PIT(S): Number of / Size each feet by feet
� �
Size of stone to be used # 7- /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.
i
SIGNATURE OF RESPONSIBLE PERSON:
DATE: l
OVER
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 installa-
tion , alteration or repair of an approved system, a new proposal must
be submitted to the Quoensbury Building Department before further
construction ,
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland ]toads
Queensbury , New York 12804
Remarks :
/own o� Qi ueen �6is+'�
BUfy�pING and ZONING DEPARTMENT J `
6a an ueensbury. Mew Yorke x 9 12801 8 .
SEPTIC D POSAL SYSTEM INSPECTI
NAME
LOCATION J
DATE
�/ PE I T NO
Sand - am - CIay - --- �-
SOIL TYPE fired? Y - NO
Percolation Test Re
M� /Inch
Percolation rate -7y
TYPE of SYSTEM:p bsorpt.ion field , tota Ierch
Length of each trench
.Depth of trenches
Size of gravel
SEEPAGE P ITS4Nuuiber o f}
Size..
Gravel size iz Ty Pe
PTP ING : P
Slag . to tank
Tank to disk. . box
Dist. box to field/ N Partial,
Openings sealed?
ES
L0CATI0N/SBPARATI SO
ft.
Foundation to tan rption � ft .
poundati.on to ab t.
Absorption to to line tY
Separation Of P is
LOCATION Sy ON plR, ERTY it i e one
Front - ear
Left side - Righ side
COMMSE14T
SYSTEM USE APppm
ED ES NO
Building Inspector
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