1989-706 of
BUILDING PERMIT
TOWN OF QUEENSBURY No
- R9� 717116�
WARREN COUNTY, NEW YORK ~'
w
4�- -+ j Na. r
00
PERMISSION is hereby granted to
OWNER of property located at t RirY.arrlenll Street Street, Road or Ave.
in the Town of Queensbury, To Construct or place a sch
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.
to
t . OwNE R'S Address is =
r
Same
m
Y
2- CONTRACTOR or alll LDE WS flame O
Sanitary XXXXX Sewer
3_ CONTRACTOR or BUILDER'S Address
Luzerne Road
Queensbury , N . Y . 12804
4. ARCHITECT'S Name
r
r�
J.
r7
5. ARCHITECT'S Address a'
C.
CA
O
- u
6. TYPE of Construction — {Please indicate by X)
'S
rp
1 I wood Frame ( } Masonry i 1 Steel ( } Rr
ek
7, PLANS and Specifications
No_ 1000 Gal . existing tank2 6 ' x 8 ' seepage pits as per plot plan
and application .
8_ Proposed Use t"
R
Sewage Alteration
R
a
$ ryc non PERMIT FEE PAID — THIS PERMIT EXPIRES S iptpmherr 6 19 91 n
0
Ilf a longer period is required an application for an extension must be made to the Building and Zoning inspector of the r
town of Clusensbury before the expiration date.)
Dated at the Town of Queensbury 049— Da' of �S�ptemht�r
(
SIGNED BY for the Town of Queensbury
Building and Zo ing Inspector
ro ,vra r• QUEENSSURY
`.� APPLICATION FOR or
f
=✓�` SEPTIC DISPOSAL PERMIT
c�
b .j
LLD EP 798.9
DATE $ Cpa
LOCATION OF PROPERTY FOR INSTALLATION J t Cc7 / Ff1/ti a
Owner's Name: c C 1, Telephone:
Address: 162 V el
Installer's Name: Pi ! ��� itr Telephone : r�.Z lr '
Number of bedrooms (residential only) r_
Total daily flow (compute (d 150 gal per bedroom)
Topography: Circle one: lat Rolling Steep Slope 6 of Slope
Soil Nature: Circle one: and Loam Clay Other /Depth: Feet
Ground Water: At what depth ? �- Feet
Bedrock or Impervious Material: At what depth :' Feet
Percolation test : Circle one: q of required required rate min. inch .
Domestic water supply: circle one: Iunici a Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank gal. ( minimum size: 1 . t700 gal.)
TILE FIELD : Each Trench ` � feet/Total system length feet
SEEPAGE PITS): Number of Size each feet by feet
Size of stone to be used # /Depth or Thickness feet
I have read the regulation on the reverse si o thi sheet and agree ab de by these
and all requirements of the Town o Rueen bur Sa itary Sewage al rdinance.
f
SIGNATURE OF RESPONSIBLE PERSON:
DATE:
OVER
Septic 5 stei:x Ins actions :
A . All applications for septic system installation , alteration or repair ,
as required by the Town of Queensbury Sanitary Sewage Ordinance , shall
be submit-Eed to the Isui .lding Department at least 24 hours before start
of construction and shall include a Falot plan showing ;
1 . ) the proposed location of tfte 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 ,
cite fields undJor drywalls
b . Nu system shall be covered before inspection and approval by the
1' uilciilig inspector . Failure to comply with this requirement may
i ' ulr it" tkie uneoverin � of the system by the installer sand a fine
uf up to $ 250 . 40 .
C . An approved copy of the plot plan shall be available on the construction
sire . 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
i.e submitted to the Quuunsbury building Department before further
cc� nsrruction ,
Town of Queensbury
BUILDING and CODES DEPARTMENT
bay and Paviland Roads
Queunbhury , New York 12804
k,�niurF: s
f,7r7�7 own of Q"ee02j9"#'y
' l BUILDING and ZONING DEPARTMENT
Bay ,and Haviland Road, R. D. 1 Box 98
oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NW E
LOCATION
33ATE �/ PERMIT NOv ----
SOIL TYPE - Sand - Loam - ClaY -
Percolation Test Required ." YES
Percolation to Min/Inch
TYPE of SYSTFM
Absorption field, . total lengt� i
Length of each trex' ch
Depth of trenches
Size of gravel_
SEEPAGE PITS-fNurn o
t f} <'
Size- f . X ft
Gravel size
PIPINGS T Pe
Bldg . to tank
Tank to list. box f
Dist. box to fiel ,
Openings sealed? YES NO Partial
Parti l
r" �
LOCATION/SEPARArfIONS : .
Foundation to k
Foundation to sorption ft
Absorption to lot line ft- '
Separati o pits
CATION YS+T OPERTY {Circip one}
Front - Rea ft side - Might side ' -
CCHMENT
SYSTEM USE APPROVED ' Y'ES NO
Buil ing Inspector
01/86 and v1
,Sri
�o
a
0
to
so
f
i