1989-705 BUILDING PERMIT
TOWN OF QUEENSBURY No. 89_705
WARREN COUNTY, NEW YCIRK .,.�
V
PERMISSION is hereby granted to Ray Supply
OWNER of property located at Upper (a jon Strppf Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Spwagin 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.
[4- ARCHITECT'S
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TRACTOR or BUILDER'S Name -�
Sanitary Sewer
TRACTOR or BUILDER S Address
Luzerne Road
NameHITECT'S Address
Crx
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6. TYPE of Construction — (Please indicate by XI
( I 'Wood Frame I ) Masonry ( I Steel I I
1. PLANS and Specifications
No. Existing tank , 2 6 ' x 8 ' seepage pits as per plot plan , and] rrn
application .
8_ Proposed Use m
Sewage Alterations p
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$ 3 00 _ PERMIT FEE PAID — THIS PERMIT EXPIRES XX September 6 1991 4=�
(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.)
Dated at the Town of Queensbu 6th Day of September 19 89
• for the Town of Queensbury
SIGNED BY
Building and oning Inspector
TOWN OF QUEr- ENSB URY
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APPLICATION FOR l f
SEPTIC DISPOSAL PERMIT
T°WA, Ofi
R4eGQ� dL f vs U+4Y
DATE 1� -- sEP
579,9.9
LOCATION OF PROPERTY FOR INSTALLATION 1,, pp- `Z. /�- -�" rt 0
UZ D�pT
Owner's Name: � C- Telephone :
Address:
Address: ',
1
Installer's Name: 1 0 , Telephone: 2 _ )� —,�- Z
]
Number of bedrooms (residential only)
Total daily flow (compute ( 150 gal per bedroom ) 4Lr _
Topography: Circle one: Fla,r Rolling Steep Slope 15 of Slope
Soil Nature: Circle one: Sand Laarrn Clay Other IDepth: Feet
Ground Water: At what depth ? -- Feet
Bedrock or Impervious 'Material: At what depth_ wwo`r Feet
Percolation test: Circle one not required required rate min. inch.
Domestic water supply: circle one: Tunicip Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTE1i : Septic Tank fSe,IA4 gal. ( minimum size: Loon gal. )
TILE FIELD: Each Trench r"' feet /Total system length —R feet
SEEPAGE PIT(S): Number of _ _ .�I Size each feet by feet
Size of stone to be used # /Depth or Thickness 2- feet
I have read the regulation on the reversefs * a of this heet and afire o ab a by these
and all requirements of the Town of Queour Sani ry Sewage s sal rdinance .
SIGNATURE OF RESPONSIBLE PERSON 7
DATE: I^ Z, 4E
OVER
Septic System LnSpecrions :
Ao 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 Building Department at least 24 hours before start
of construction and s511--111 include a plot Plan showing :
1 . ) the proposod location of Clio system
� . } locQCIon 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 .jnJ / or drywells
b . No system shall be covered before inspection and approval by the
1, uiidil-4g lizspvctor . Failure to comply with this requirement may
result in the uncovering of the system by the installer and a fine
uz 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 r� Fjair of an approved system , a new proposal must
hu submitted to the Qu� unsbury Building Department before further
LUIIStruction .
Town of Queensbury
BUILDTNC and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
k� nlorks
7.R v/ 'Quee►zslSury
BUILDING and ZONING DEPARTMENT A
.
Bay and Haviland Road, R. D, 1 Box 98 I
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME .—.
LOCAT I UIv
BATE f_ PERMIT NO. 7C.
SOIL TYPE Sand. - Loam - clay, "-
Percolation Test Required? Y S - NO
PercolationI ate - Min/Inch
TYPE of SYSTEM :
Absorption field , total l gth
Length of each trench
Depth of trenches ---
Size of gravel
SEEPAGE � ITS4N p
Size-SEEPAGE
Gravel. size
PIPING : Size Type
Bldg . to tank
Tank to d-isst _ bo
Dista boy: to fie d/ NO
Yl�
Openings sealed E Partial
LOCATION/SEPA TIONS :Foundation t tank ,3
Foundation t i absorption ft. Y
Absorption lot line �t ,
Separation f pits t.
of ON SYSTEM ON PRQPERTY�(s• y�-de e )
ron - Re r - Left side -�ght �ide�
C NTS :
SYSTEM. USE APPROVED YE NU
Bui ing Ins ctor
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