1989-427 P3
BUILDING PERMIT
TOWN OF QUEENSBURY No. r, q 427
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to
OWNER of property located at Street, Road or Ave.
in the Town of Queensbury, To Construct or place a
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.
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OR or SUI LDE R S Name
SepticOR or BUILDERS Address
alls , N . Y . 12801
4. T'S Name tr
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S. ARCHITECT'S Address
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struction — (Please indicate by X)
Wood Frame I ? Masonry ( Y Steel ( 1
andpecifications
Existing 1000 gal . tank , 2 f ' x 8 ' seepage pits as per plot plan
and application .
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$ 75 fyR PERMIT FEE PAID — THIS PERMIT EXPIRES shing 15
(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.) p
Dated at the Town of Queensbury this Day o 799
111111111
for the Town of Queensbury
SIGNED BY
Building and Zoning nspector
-OWN OF QUEENSBURY
TOWN OF OUEENSBURY
APPLICATION FOR RECEIVED
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SEPTIC DISPOSAL PERMIT , UN 121989
BLDG. &. CODE DEPT.
DATE 'fJ
LOCATION OF PROPERTY FOR INSTALLATION --�}
Owner's Name: / f f Telephone : +'
Address:_. l Lr' iJ /7
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Installer's Name ,17 ,Q V -3 ,rCa 2 C L C. -- Telephone:
Number of bedrooms (residential only)
Total daily flow (compute Cd 150 gal per bedroom)_
Topography: Circle one: Flat Rolling Steep Slope % of Slope
Soil Nature: Circle on . Sand Loam Clay Other !Depth : Feet
Ground Water: At what depth ' /yea �L/ � Feet
Bedrock or Impervious Material: At what depth '? A/ o.*PVP//.,,,,yy��_��Feet
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Percolation test: Circle one: not required required rat -4 min. inch .
Domestic water supply: circle one: lunicipal Well Other
If domestic water supply is a wel
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank FX15 •gal. ( minimum size: l , 000 gal. )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of size Size each feet by _,t!L feet
Size of stone to be used #,2./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 Sewage Disposal Ordinance.
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SIGNATURE OF RESPONSIBLE PERSON:
DATE : +.
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 bepartment 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 ,
file fields and / or drywells
b . No :system shall be covered before inspection and approval by the
iiuiiding Inspector . Failure to comply with this requirement may
result in tine 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
he submitted to the Queensbury B " ilding Department before further
Construction ,
Town. of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
ken�;irk5 :
- Jocun a/ QueenJ9 "rt&4
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D, 1 Box 98
C]ueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
DATE Q14 / PERMIT NL7.
SOIL TYPE - an - Loam - Clay -
Percolation Required? YES - NO
Percolation rate Min/Inch ,
TYPE of SYSTEM:
Absorption field , t tal length
Length of each trench
Depth of trenches
Size of gravel - r
SEEPAGE I S{Numb of)
Size- ft. X _ ft,cv
Gravel size
PIPING : size Type
Bldg . to tank r -J`'�
Tank to dirt . box
Dist. boX to fie /
Openings sealed? ES NO Partial
LOCATION/SEPA IONS :
Foundation to ank ft-
Foundationto absorption ft.
Absorption t lot line f t-
Separation
o pits ft.
LOCATION OF SYSTEM ON PROPERWIP=:s1de
Front
- Rea - Left side figCOMMENTS :
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JEW ;►tit$.
SYSTEM USE APPROVED&ESO
Builain -pector
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