1989-309 BUILDING PERMIT x
QV
QV
TOWN OF QUEENSBURY Na. 89- 309
�'�'� � ✓� � WARREN COUNTY, NEW Yl7RK w
r.,
E
PERMISSION is hereby granted to Wilson Mathias �r
pp �� rx
OWNER of property located ati A �""A^> is Street, Road or Ave.
in the Town of Queensbury, To Construct or place a 5ewa_ue Alteration
at the above location in accordance to application together with plat 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 3
--a
RR#5 Box 258 Gurney Lane
ueensbur N . Y . 12804
2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer
c
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
C
c
S. ARCHITECT'S Address �
-C
r
CD
m
6. TYPE of Construction — (Please indicate by X1
( ) Wood Frame ( 1 Masonry ( ) steel ( 1
7. PLANS and Specifications
No. Existing 1000 gal . tank , 210 ' the field as per plot plan and
application .
tr
ro
8. Proposed Use X
ua
Sewage Alteration
CD
CD
s
sw
sw
$ 25 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES May 12 19 91
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the 'O
town of Queensbu ry before the expiration data]
Dated at the Town of Queensbury this 2!lth y of May 1989
SIGNED BY for the Town of Queensbury
Building and Zoni specter
TOWN Or, QUEENSBURY
U.+APPLICATION FOR of
SEPTIC DISPOSAL PERMIT
DATE
ry'
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: i C J, 4&AJ p Telephone*
Address:
Installer's Name:'% rXJ i 22" c/ 4,4� Telephone: 7 9.�
Number of bedrooms (residential only) t
Total daily flow (compute Cd 150 gal per bedroom)
Topography: Circle one Fla Rolling Steep Slope % of Slope
Soil Nature: Circle on • San Loam Clay
Othe y✓t.(" /Depth: Feet
Ground Water. At what depth ? Feet
Bedrock or Impervious Material: At what depth ? ~` Feet
Percolation test: Circle one: of require required rate min. inch.
Domestic water supply: circle one: Municipal ell Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank ePsr/w6gal. (minimum size 1 , 000 gal.
TILE FIELD : Each Trench... feet/Total system length - 21 C) feet
SEEPAGE PIT(S): Number of / Size each /feet by -- feet
Size of stone to be used # 2� /Depth or Thickness / feet
I have read the regulation on the reverse side of heet and agree to abide by these
and all requirements of the Town of C ueensb y Sani ary Sewage is sal Ordinance.
SIGNATURE OF RESP 1NSIBLE PERSON:
DATE:__u ~� /+f
OVER
ti
Septic System Inspections :
Ae 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 hour :; before start
Of cOas truction azid shall include a plot plan showing :
1 . ) the proposed location of the system
? . ) location and distance to lot lines
3 . ) 10CatiOn a:id 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 Inspuctor . Failure to comply with this requirement may
rLsult in the uncovering of the system by the installer and a fine
of up to $ 2150 . 001
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
c: o1istruct ion ,
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
awn O/ Q"een36ter�
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road. R.D. i Box 98 '
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION
DATE �� PERMIT NCI .
SOIL TYPE - Sand - Loam - Clay
Percolation Test Required? YES - NO
Percolation rate - Min/inch
TYPE of SYS `
AbGorption 7fldr total leng lLength of etrenc 'Depth of tr sSize of graSEEPAGE PIT er of)
Size- fX
Gravel size
PIPING : S ' Ty e
Bldg . to tank ;
Tank to list . box
Dist. box to field/ L✓
Openings sealed? Y S NO Partial
LOCATION/SEPARATI91 S
E oundation to t f f_ dit.
Foundation to ab orpti ft-
Absorption to 1 t line _ ft.
Separation of its ft•
LoOCATION STEM CN PRO 'RTY (circle one)
Front - ear Left side - fight side -
COMMENT
SYSTEMS USE APPROVED YES N
r
S3u ing Inspector
01/86 and v1
L f�
t f
4
t t7 v Am
e / �
bey,
(o _ 34) ' e�,cG �
Grp ``