1989-668 - I
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BUILDING PERMIT x
TOWN OF QU EENSBURY No. 89- 668
WARREN COUNTY, IVE1N 4'{JRK CD
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PERMISSION is hereby granted to � nonal ri Sokol rn
OWNER of property located at 3R Helen f1 yp Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Sewagin 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
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2. CONTRACTOR or BU1 LDER'S Name
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Queensbury Sewer
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3. CONTRACTOR or BUILDER'S Address
Glens Falls , N . Y . 12801
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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B_ TYPE of Construction — (Please indicate by X) _..
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( 1 Wood Frame I l Masonry I I Steel I I
7. PLANS and Specifications
No, 2 6 ' x 8 ' seepage pits as per plat plan and application ,
8. Proposed Use
Sewage Alteration M
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$ _ 2R - nf1 PERMIT FEE PAID — THIS PERMIT EXPIRESAugust T9_9i
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the ro
town of Queensbury before the expiration date.} DO
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Dated at the Town of Queen this 22nd day of August 19,_. 9
SIGNED BY for the Town of Queensbury
Buitdingm5nd Zoning Inspector
TOWN OF QUEENSE URY ■qrilt
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; : -•. 1 APPLICATION FOR r;e n � � T --: � 4' . , E �
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✓F , -� SEPTIC DISPOSAL PERMIT
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DATE
DATE
LOCATION OF PROPERTY FOR INSTALLATION � [a .Z/�6,'/v �r+
Owner's Name Telep'hone:
Address: A.
Installer's Name: Telephone:/ :
Number of bedrooms (residential only)
Total daily flow (compute (d 150 gal per bedroom ) V1Z)
Topography: Circle one: lat Rolling Steep Slope 06 of Slope
Soil Nature: Circle one- a d Loam Clay Other /Depth : Feet
Ground Water : At what depth ? Feet
Bedrock or Impervious '%Material: At what depth ? Feet
Percolation test : Circle one: n re uiir required rate min. inch.
Domestic water supply: circle one: unici Well Other
If domestic water supply is a wel
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank gal. ( minimum site: 1 . 000 gal.)
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of 'Size each jg�w �feet by i!!� feet
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Size of stone to be used # /Depth or Thickness 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 Sanitary Sewa Disposa4 Ordinance.
SIGNATURE OF RESPONSIBLE PERSON :
DATE:_ e
OVER
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 skull include a plot plan showing :
1 . ) Elie proposed location of .tlx4 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 ,
the fields and / or drywells
B . No system shall be covered before inspection and approval by the
Isuilding liYspuctor . Failure to comply with this requirement may
result in Elie uncovering, of Che 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
situ . 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
t)v submitted Co the Queunsbury Building; Department before further
� oixurruction .
Town of Queensbury
BUILDINC and CODES DEPARTMENT
Bay and liaviland Roads
Queensbury , New York 12804
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