1988-790 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 88-790 •
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WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Curtis Mayott
OWNER of property Iocated�tv0X4 Dixon Road 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 BUILDER'S Name N.
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Edward Ladd
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3. CONTRACTOR or BUILDER'S Address rt
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4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
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( )Wood Frame ( ) Masonry ( ) Steel ( )
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7. PLANS and Specifications a
No. 1000 gal tank, 1 8x8, seepage pit as per plot plan
and application.
8. Proposed Use
Sewage. alteration
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$ 10.00 PERMIT FEE PAID—THIS PERMIT EXPIRES October 11, 19 90
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(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.)
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Dated at the Town of Queensb�urr is l lth Day, of October 1988 1-1`�` f rr
SIGNED BY .c�yUZ1 e for the Town of Queensbury 0
Building and Zoning Inspector
TOWN OF QUEENSBURY6c
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APPLICATION FOR 7
1988
401 c13/ .
. -'--A ? ;1 q ; '2 '' SEPTIC DISPOSAL PERMIT BUILDING & CODE DEPT.
,4111. , . .:.. - . 49 400(
D ,idic•TE �� /
LOCATION OF PROPERTY FOR INSTALLATION 45 4, ,fi ,c.r9
Owner's Name: ) CXTelephone:
Address:),V-/f 57.s/2�i_,..t. , r- , /
Pi -Installer's Name: 7C Telephone: () .3 %1,3 C
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) c_3 c' (:
Topography: circle on:1"
'oiling Steep slope % of slope
Soil Nature: circle on- : and Loam Clay Other / Depth: feet
Ground Water: At what depth? -et
Bedrock or Impervious Material: At w . pt, feet
Percolation test: circle one: not .eqi re.,/ equired/rate_min.inch.
Domestic water supply: circle on: : Municip.l ell Other
If domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM: Septic Tank /// 'gai. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE.PIT(S)•: Number of / / Size each /feet by feet
Size of stone to be used # jDepth or Thickness 2 _ feet
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. 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 responsi e person( �Ld '
Date: /I p e '
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(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,
tile 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.
C. 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 Queensbury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
Remarks:
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