1990-138 BUILDING PERMIT y
TOWN OF QUEENSBURY No. 90-138
WARREN COUNTY, NEW YORK z
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PERMISSION is hereby granted to SHALAUB °ice'
OWNER of property located at 191 Dixon Rd 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 0>
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2. CONTRACTOR or BUILDER'S Name
Queensbury Sewer
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) '
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. Sewage Alteration-1000 gallon tank, tile field; to specifications and
application fD
8. Proposed Use
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Sewage Alteration
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 10 19 92
(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 /10th Day of April 19 90
SIGNED BY for the Town of Queensbury
Building and Zoning I sector
TOWN OF QUL•ENS8URY -
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`� OWN OF QU�EENSBUR
r;r /\/ APPLICATION _ 'CE1VEO
i\ SEPTIC DISE SA 'E' -; IT
`\ ;ti APR 091990
BLDG. & CODE DEPT.
DATEMOAS G C,)
LOCATION OF PROPERTY FOR INSTALLATION— i 0
Owner's Name://1 f2• 5.1_J.a j a <. b Telephone:
Address: I . I ( I cf 6- /a
Installer's Name:ec)_( , -e (..e. 7 Telephone: 7 .y( v-sz
Number of bedrooms (residential only) .2 —
Total daily flow (compute (d 150 gal per bedroom) g UZ -
Topography: Circle one: at Rolling Steep Slope % of Slope
Soil Nature: Circle one:Sand Loam Clay Other /Depth: Feet
Ground Water: At what depth? Feet
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle one not require required rate min. inch.
Domestic water supply: circle one: iiunicipa�'i Well Other
If domestic water supply is a well:- l
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM: Septic TankZ. gal. (minimum size: 1.000 gal.)
TILE FIELD: Each Trench feet/Total system length /SZ feet
SEEPAGE PIT(S): Number of / Size each feet by feet
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Size of stone to be used # 2. /Depth or Thickness / 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 Queer Sanitary Se ge Dispos 1 Ordinance.
SIGNATURE OF RESPONSIBLE PERSON .
DATE: q,,P �` �6
OVER
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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
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Remarks : .
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Jocun of Queeniur,
BUILDING and ZONING DEPARTMENT .
Bay and Haviland Road, R.D. 1 Box 98 /7
Queensbury, New York 12801
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SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION i/9'/ / 0 )2),W,
DATE AOl /90 PERMIT NO. 9/)--4M
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate Min/Inch
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TYPE of SYSTEM: i
Absorption field, total length /�j c�
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Length of each trench ,� %3 ���
Depth of trenches
Size of gravel tt•},(2-.-
SEEPAGE PITSf Nuinbe of) _ /
Size- ft. X. ft. •
Gravel size
PIPING: Size Type
Bldg. to tank ti r(PA,
Tank to dist. box ''! 1 " ; OVe
Dist. box to field/i:li / pvc,
Openings sealed? ilipp NO/ Partial
LOCATION/SEPARATIONS: ,ty
Foundation to tank 'c; ft.
Foundation to absorption) 05 ft.
Absorption to lot line /0 ft.
Separation of pits ft.
LOCATION OF SYSTEM ON P OPERTY(circle one)
Front -t Left side -\Right side -
COMMENTS: a
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SYSTEM USE APPROVE• 0 1
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//� Buil. 447. nspector
01/86 and vl
OWN of QUEENsEUm
RECFil -,
APR 0 9 1990
BLDG. & CODE DEPT.
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TOWN OF QUEr,NS1311.tY
ALDN 6i-tiONS •
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E1EVIEWE BY WI
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