1988-934 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 88-934
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Robert Kaufman
OWNER of property located at 12 Sylvan Avenue 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
2. CONTRACTOR or BUILDER'S Name
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Sanitary Sewer
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3. CONTRACTOR or BUILDER'S Address
P.O.Box 224
Glens Falls,New York 12801
4. ARCHITECT'S Name
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5. ARCHITECT'S Address - F
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6. TYPE of Construction—(Please indicate by X) 0
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( )Wood Frame ( ) Masonry ( ) Steel ( )
7. PLANS and Specifications
No. Existing 1000 gal. tank, 2-6'x8' seepage pits as per plot plan,
and application.
8. Proposed Use
Sewage Alteration
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES X December 12 19 90
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the rr
town of Queensbury before the expiration date.) ro
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Dated at the Town of Queensbury • 12 Day of December 19 88
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SIGNED BY aoz for the Town of Queensbury
Building and oning Inspector
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79-; APPLICATION FOR SEPTIC DISPOSAL PERMIT 2DUllG Ut.DO CUUU t�[l'f.
10 or 4u[u:;uu�rr
DA1'l'E d c)-- /c ./ P ,
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LOCATION CV PROPERTY•FOR INSTALLATION S `k .
Owner's Name: £cAr kA- UFRA-Ai Telephone: 7 13 - O S''Z
- AdLlr-ess: J ..- Lv;4 / Ave- — -
Installer's Name: �^�
r �) p, i i�it y ��ct,%2.( Telephone: -2 q) - '2? 6-'1
Number of bedrooms (residential only)
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Total daily flow (compute @ 150 cal per bedroom) — ytj 17 • •
TopoLrapby: circle one: Fla Rollinf; Steep Slope 9.; of slope _
Soil Nature:. circle one: 8 Loam Clay Other / Depth: feet
Ground Water: At what depth? feet .
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Bedrock or.luipervious Material: At what depth? — feet
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. PercuLition test: circle one:(ot required required / rate min. inch.
. Domestic water supply: circle one: unicipa Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption . — feet
PRGi'OSla S1°5'1'1_A17 Septic T, Ek/Ji/416,- /oD(min-9,4 0,')imum size: 1,000 0a1.)
TILE FIELD: Each Trench _ _ feet / Total system lentth — feet
SEEPAGE PIT(S): Number of / Size each feet by d"_ feet
Size of stone to be used 1/ g / Depth or Thickness 2 feet
"rr• ♦ i i i • •' ♦ ♦ i i i i i is i 3 i 444444 . 44 4. 444444 i <j i,,sn N,
IMPORTANT
...Please...LIST NEW L'RUll'MLN'1"1'O lil~INSTALLED_- `•''°` Y _,v �.,j;�`
♦ i 44 ♦' ♦ ♦ * 1 •7 4 ♦ 4 4 ♦ s i V ♦ 4✓ v p :'S
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•Section II • Septic System Inspections:
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A. . All applications for septic system installation, alteration or repair, as
• • required by the Town of Queensbury Sanitary Sewage. Ordinance,
. be submitted tp the Buildingliepiulnient at least 2-A-.hour s before start •
of construction and shall include a plot plan showing:
• 1.) ;the proposed location of the system
Z.) . location and distance to lot lines •
• 3.1 •location and distance to structures •
location and distance. to any water supply
.. 5.). si•ze. and dimensions of all tanks;distribution
' boxes,-tile fields and/or drywells
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• 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.
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D. ; .Should unforeseen problems during construction prevent proper installation, •
alteration or repair of an approved system, a new proposal must• be submitted
• to the Queensbury 13uilding Department before further construction.
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I have read the regulations above and a e to abide by these'and all requirements
of the Town of Queem.bury Sanitary ewag • Disposal Ordis - cc.
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.Signaturp of responsible person:
Da Le:, 1,1-/ P
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Town of Queensbury
• • . Building and Code_Department • •
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Bay at Haviland Road •
• • Queensbury, New York 12801
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(518) 792-5832 '•••
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Jown of Queeniur , .
BUILDING and ZONING DEPARTMENT
Gde./ Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
!A '
,SEPTIC DISPOSAL SYSTEM INSPECTION
NAME ,��'-/ . /! ZL GC/12.)
LOCATION jig 410te/42)
DATE 4 -lit- PERMIT NO. er-ggi
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES -.NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption\field, total length
Length of each trench ' '
Depth of trenches '
Size of gravel,
SEEPAGE 'ITS{Nuinber of) _ �/y
Size- � ft. X ft. .-�
f/�-- 7
Gravel size .
PIPING: Size. Type
Bldg. to tank ,. (,Sff/.t�:
Tank to dist. box _ ,'Cr. /1)12C"
Dist. box to field_Rit=, f1t/ef.—
Openings sealed? ( YES' 'k NO Partial
LOCATION/SEPARATION f--
Foundation. to tank !St.
Foundation to absorption _ 7...'gt.
Absorption to lol/line l ft.
Separation of pits 2ft.
LOCATION -. YSTEM ON PROPERTY`(circle one)
Front - ear - Left side - Right side -
COMMENT
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SYSTEM USE APPROVED ' 'ES� NO
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Building Inspector
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RV1EVV ED BY
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