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1989-643 BUILDING PERMIT TOWN OF QUEENSBURY No. a WARREN COUNITY, NEW YORK � L 17 00 r r � PERMISSION is hereby g ranted to =ail`"') Rich Street. Road or Ave. OWNER of property located at tJ`-' 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. t. OWNER'S Address is Same 'x c t� 2. CDNTRACTOR or BUILDER'S Name Sanitary Sewer Service n a 3. CONTRACTOR or BUILDER'S Address G b,axwx Luzerne Road ueensbu 4. ARCHITECT'S Name 5_ ARCHITECT'S Address IIIIIIIIIIIIIIIIII S. TYPE of Construction — (Please indicate by XI ( I Wood Frame ( l Masonry { ) Steel I 1 7. PLANS and Specifl call Ong No. 1000 gal. XXX tank, 1 S' x 8' seepage pit as Per plot plan and application. a. Proposed Use Sewage Alteration $ � � nfl PERMIT FEE PAID — THIS PERMIT EXPIRES Are t_ (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 dat" _ f 9,49' Elated at the Town of Queensbury this Day of + : for the Town of Queensbury SIGNED BY gul ing and Zoning 1 ctor TOWN OF {, UEE- NSUUPY � � 45"6"� P11W W # " APPLICATION FOR 4m (a7 SEPTIC DISPOSAL PERMIT DATE JZ) © f LOCATION OF OPERTY FOR INSTALLATION [), JtL. (] j1yj(Dj Owner's Name: '- t � Y as Telephone: Address: Installer's Name. C hp�,.�. �U- ,.3f� ..]taJITelephone: Number of bedrooms (residential only). Total daily flow (compute ( 150 gal per bedroom ) Mb Topography: Circle one: Flat Rolling Steep Slope % of Slope tSoil Nature: Circle one: San Loam Clay Other /Depth : Feet Ground Water: At what depth ? &i I PC- Feet Bedrock or Impervious Material: At what depth? Feet Percolation test: Circle one: norequired required rate min. inch. Domestic water supply: circle one: Municipal ell Other If domestic water supply is a well: Separation: Water supply from septic absorption l S<) --r- feet PROPOSED SYSTEM * Septic Tank IC)60 gal. ( minimum size: 1 ,000 gal.) TILE FIELD: Each Trench feet/Total system length feet SEEPAGE PIT(S): Number of / Size each feet by 8 feet Size of stone to be used # /Depth or Thickness r 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 Queensbury San ' ry Uwage D ' osal Ordinance. SIGNATURE OF RESPr�ONSIBLE PERSON: DATE: OVER septic system £nsspectlons : 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 20 ) 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 lsuilding laspuctor . 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 BUILDTNC and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York 12804 R toarks ._../+a41/►� Ci� �flk'ert3 [�+fatl'!�f BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R,D- 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION LOCATION ..rt rr QERM4IT NO . 0'% - t! 5``. SOIL TYPE - Sand - 1;65 ') Clay Percolation Test Required? YES - NO �✓ Percolation rate - Min/Inch _ TYPE Of SYSTEM: Absorption £ielV al length Length of each Depth of trench r Size of gravel_ �_---- --�'— SEEPAGE P ITS-FNu £} --~-� - Gravel size :;i2e r"l� f"s� P IP I13C? : Bldg . to tank j rr Tank to list . box Dist. box to field/ lt✓ artial Openings sealed? ES NO P r� LOCATION/SEPARATIONS :} Py, £t. Foundation to tank ' t . Foundation to absor tion AbsorPtion to lot line f Separation of Pita LOCATION OF SYSTEM ON PROPERTY (c 't le one? Front ar T,4sft side - Right Cf1M� ` f SYSTEM USE APPROVED Y NO Building inspector O1/86 and v1 la s to � 1 ! VON r � rI f f