1989-725 —I
BUILDING PERMIT
TOWN OF QUEENSBURY No. R9_ 7 25%
WARREN COUNTY, NEW YORK
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PIER MFSSION is hereby granted to William Roach
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OWNER of property located at 2 Midnight Drive Street. Road or Ave.
in the Town of Queensbury, To Construct or place a age 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
74
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Same y
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2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer
CONTRACTOR or BUILDER'S Address
Luzerne Road
Queensbury , N . Y . 12804
4. ARCHITECT'S Name
5. ARCHITECT'S Address
J.
LAM
6. TYPE of Construction — (Please indicate by X) J.
C
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( } Wood Frame ( P Masonry I ) Steel 4 1
7. PLANS and Specifications
No. Existing tank , 2 6 ' x 8 ' seepage pits as per plot plan and applicatiait .
B. Proposed Use
Sewage Alteration
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$ M00 PERMIT FEE PAID — THIS PERMIT EXPIRES September 12 19 91
(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.) �'►'
J.
O
Dated at the Town of Queensbury this 12 Day of September 19
89
SIGNED BY c*�� for the Town of Queensbury
g Buildin and Zoning nspector
FOWN OF QUEENSBURY
APPLICArnON FOR 7
SEPTIC DISPOSAL PERMIT dWIV Ri~Q Ver) aUFqy
SEP
DATE,� cf f] T
LOCATION OF PROPERTY FOR INSTA1:' ATION• � /
I Owner's Name: / LJ , F� // �1P� ._ Telephone: ~' �s
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Address: �^
Installer's Name: Telephone: %
Number of bedrooms (residential only) u y s
Total daily flow (compute Cd 150 gal per bedroom s
Topography: Circle one: Flat olling Steep Slope 06 of Slope
Soil Nature: Circle ones, 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 equired required rate min. inch.
Domestic water supply: circle one• Municipal Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic TankG SS//+' ) gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S). Number of j Size each j feet by feet
Size of stone to be used # /Depth or Thickness_ feet
I have read the regulation on the reverse sid is sheet and agree go abide by these
and all requirements of the Town of Queen y S nary Sewa spo al Ordinance.
SIGNATURE OF /R�rESPONSIBLE PERSON:
DATE:
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 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 ,
rile fields and / or drywalls
BO Nu 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
UI 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—
[ ion , alteration or repair of an approved syste[a , a new proposal must
tau submitted to the Queensbury Building, Department before further
construction .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Say and Haviland Roads
Queensbury , New York 12804
keni : rks
_Journ of 'QueenjImry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. DI 1 Box 98 G
{Queensbury, New York 12801 F 030
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCAT I ON � , p
DATE I PERMIT NO .
SOIL TYPE - Sand - Loam - C1aY
Percolation Test Required? YES - NO
percolation rate - Min/Inch kkk
TYPE of 3YSTEMI :
Absorption field , . total length
Length of each tr 'nch
Depth of trenches
Size of q rave1
SEEPAGE �=s4Numb f)
Size- Y,.mft. X - ft .
Gravel size
PIPING : S1 T ve
Bldg * to tank '
Tank to clist . box
Dist_ boy: to field/pi
openings sealed? Y S<: NO artial
LOCATION/SEPAR.ATI
Foundation to tan ft.
Foundation to aks rption ft.,
Absorption to to Line ft0
Separation of p ' s ft.
LOCATI YS ON PROPEF - (circle one)
Front _ ear - eft side - Right side -
CCHMENTS :
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SYSTEMS USE APPROVED ES NO
S3uildin Spector
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