1990-184 BUILDING PERMIT 1-3
TOWN OF QUEENSBURY . No. 90-184
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PERMISSION is hereby granted to GREGORY LEONARD c.,
OWNER of property located at 42 Wintergreen 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.
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1. OWNER'S Address is Z
same
2. CONTRACTOR or BUILDER'S Name
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Fred Smith
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
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5. ARCHITECT'S Address m
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( ) Steel ( )
7. PLANS and Specifications
No. Sewage alteration to include 1000 gallon tank, 2-87x8' Seepage pits with w
#2 stone at 2' depth as per specifications and application. a'
8. Proposed Use
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Sewage alteration P2,
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 23 19 92 o
(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 d Day of April 19 90
SIGNED BY r/ for the Town of Queensbury
Building and Zoning nspector
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s �,�- APPLICATION FOR f
'-`��''� SEPTIC DISPOSAL PERMIT '
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LOCATION OF PROPERTY FOR INSTALLATION /o2 W// ieG1 6 g 231990
Owner's Name: 6 E6o4y. LSO 4Rf Telephone: 7?c2-dgj, UILDING & CODE DEPT.
Address: y02 I/L11A1!:..e6R AJ 71iD
Installer's Name: /---A-- U 94704 Telephone: 79g-/g36 793--atozg
Number of bedrooms (residential only) 3
Total daily flow (compute a 150 gal per bedroom) 450
Topography: Circle one4119
Rolling Steep Slope % of Slope
Soil Nature: Circle on-: 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 required required rate min. inch.
Domestic water supply: circle one: Munici a Well Other
If domestic water supply is a we 1:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM: Septic Tank /v°® gal. (minimum size: 1.000 gal.)
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of 2._ / Size each g feet by y feet
Size of stone to be used# L- /Depth or Thickness 2 ' / feet
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I have read the regulation on the reverse side of is sheet and agr a to abide by these
and all requirements of the Town of Rueensbur; nitary SewagVsposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: �% LeriWee
DATE: 1004
OVER
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Septic System Inspections:
A. . All appiicacions for septic system installation, alteration or repair,
1a1. ls .�equit!ed byi the(Town of. Queensbury Sanitary Sewage Ordinance, shall
F f� e -submi�ttee �co 'the :Building Department at least 24 hours before start
--of copptruc,tion and_ sha11 include a plot plan showing:
1.) the proposed location of the system
.rC'3f, `2&-ld~eieioni4hl distance to lot lines
3.) location and• distance to structures
4.) location and distance to any water supply -
5.) size and dimensions of all ranks, distribution boxes,- _
rile 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.
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Town of Queensbury
BUILDING and CODES DEPARTMENT
'Bay and Haviland Roads
Queensbury, New York 12804
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Remarks: •
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BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
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SEPTIC DISPOSAL SYSTEM INSPECTION
NAME LF-p,JA-12.-.d
LOCATION L)2C(J!,V j t, (�--&A/ ��`
DATE /3c�/ r(0 PERMIT NO. , �O—I (Y
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SOIL TYPE Sand - Loam - Clay,; -
Percolation\Test Required? YES - NO
Percolation irate - Min/Inch '
TYPE of SYSTEM:
Absor ' n field 1 len
L th of 1trench ___..----'
Dept trenc
Size of gravel ";,
SEEPAGE PITS{Number of)
Size- a ft. X J'b ft. (
Gravel size . _�-
PIPING: \ Size; Type
Bldg. to tank g-KCs I-7
Tank to ciist. box \ y` pv c--
Dist. bo): to field/6------
)9V-cOpenings sealed? ; NO Partial
LOCATION/SEPARATIONS: ,.i ' f
Foundation to tank "i., / ?fit
Foundation to abscrption Zct.f -
Absorption to lot line `; , y t.
Separation of pits ;,/5 ft.-1-----
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - CRight side -
COMMENTS:
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SYSTEM USE APPROVED ES O %4
Bull ing n ector '.
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