1989-601 X
BUILDING PERMIT
b
TOWN OF QUEENSBURY
No. —29� 6n1 0
52q5 . ( 4 Y � WARREN COUNTY, NEW YC7R K r°°,,,
2 c,a
PERMISSION is hereby granted to Nel e5 Inc ,
OWNER of property located at 4 Hummi ngbi rd Lane Street, Road or Ave.
in the Town of Queensbury, p t +era t
To Construct or lace a Sewage 3
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.
t_ OWNE R'S Address is
SXit6# 145 Murray Street
Glens Falls , N . Y . 12801
47
2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer
3_ CONTRACTOR or BUILDER 'S Address
BOX 224
Queensburys N . Y . 12804
.p,
4. ARCHITECT'S Name
s
c
r�
5. ARCHITECT'S Address Cr
J.
d.
r
cu
6_ TYPE of Construction — (Please indicate by X) CD
ro
{ ) wood Frame { I Masonry I I Steel ( I
7. PLAINS and Specifications
No_ 1000 gal tank , 2 6 ' x 8 ' seepage pits as per plot plan , and
application .
Lon
8. Proposed Use
Sewage Alteration
e
$ 25 00 PERMIT FEE PAID — THIS PERMIT EXPIRES July 31 19 91VU
(If a longer period is raquired 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 Queensbur 31s t y of j u 1 19 89
SIGNED BY for the Town of Queensbury
13ulid inga ning Inspector
TOWN OF QUELNSBUR . Y
r VR
LSd f"'a R • f^+ ^r +4 w APPLICATION FOR BU # S F.
SEPTIC DISPOSAL PERMIT • _ , . r
EP
3 - � - / DATES
DATE
LOCATION OF PROPERTY FOR IN' ST` ALLATION I XZM /-r
Owner's Name: I uJ� �' �' '� ' Telephone:
Address: Z' ]�<�)
Installer's Name: `.+ /F} �t� , 11� �r: r� Telephone: mL -
Number of bedrooms (residential only)
Total daily flow (compute Cd 150 gal per bedroom)
Topography: Circle one: Pia Rolling Steep Slope 06 of Slope
Soil Nature: Circle one: 0
Loam Clay Other /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: . Iunicipa Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM . Septic Tank 1 000 gal. ( minimum size : Loon gal.)
TILE FIELD : Each Trench feet/Total system length Y feet
SEEPAGE PIT(S): Number of2� _/ Size each feet by feet
Size of stone to be used # /Depth or Thickness 2 feet
I have read the regulation on the reverse si is sheet and agr o abide by these
and all requirements of the Town of QueeilfsbU S itary Sewa is al Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
DATE: 7fir �3,� '
OVER
c ot
Septic System Inspections :
A * ." 1 applications for septic system installation , alteration or repair ,
as required by the Town of Queensbury Sanitary Sewage Ordinance , shall
be submit-ted to the Building Department at least 24 hours before start
Of construction and shr111 include a plot plan showing :
1 . ) the proposed location of tfju system
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 ,
rile fields ant / or drywells
D . N: ; ystern shall be covered before inspection and approval by the
:iuilding Iitsp� ccor . Failure to comply with this requirement may
result in tfic uncover .in4 of the system by the installer and a fine
of up to 250 . 003
C . rn 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 proposral must
lie submitted to the Queunsbury building Department before further
cuiistruction .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
ken�arks
awn a/
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME G �"
LOCAT II ON
FATE PERMIT NO* ll �%
SOIL TYPE - an - Loam - Clay .,-'
Percolation s equired? YO; - NO
percolation rate Min/inch
TYPE of SYSTEM:
Absorption field , t tal 30ength
Length of each trenc
Depth of trenches -
size of grave]:_
SEEPAGE PITS4Nuinb r
Size- Lft. XX t'
Gravel size - —
PIPING : Si a TY
Bldg . to tank Co :
Tank to list .
Disto box to f ' ld/pOt u Y+
Openings Seale 7 YES Partial
LOCATION/SEP TIONS :
Foundation tank ft'
Foundation o absorption ft _
Absorption Jr-to lot line r_-r t.
Separation' of pits
LOCATION OF SYSTEM ON pRopERTY ( ' rcle one)
Front - Rear - Left Side - Right ide -
C CMMENT S :
SYSTEM USE "PROVED , YES NO
i
r )
Buildin nspector
01/86 and V1
on
0 �Sep
14)
OF
1 �
or
I�! N