1989-760 BUILDING PERMIT
;
TOWN OF QUEENSBURY {
No. _ 22_7150
WARREN COUNTY, NEW YORK 4
PERMISSION is hereby g,"rraaanteedd to Gilbert Boehm �
OWNER of property located at * Route 5L Street, Road or Ave_
in the Town of Queensbury, To Construct or place a Sewage 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.
t. OWNER'S Address is q
Same F
s
2. CONTRACTOR or BUILDER'S Name
Queensbury SEwer r
s
3. CONTRACTOR or BUILDER'S Address
861*1 Glens Fa71s , N . Y . 12801
4, ARCHITECT'S Name
6, ARCHITECT'S Address
i
6_ TYPE of Construction — (Please indicate by X)
1
( } Wood Frame [ ) Masonry I I Steel I }
7_ PLANS and Specifications
No. Replacement of existing steel tank only as per plot plan and
application .
8. Proposed Use
it
Sewage Alteration
$ 25 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES April 1 19 90
(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 Queensbury this 2rh± b ❑ay of September. 19
SIGNED BY =/ �_ for the Town of Queensbury
Building and Zo ng Inspector
TOWN OF QUEE- NSBURY
APPLICATION FOR
SEPTIC DISPOSAL PERMPr
4V _ �r _ I
DATE
LOCATION OF PROPERTY FOR INSTA/ ....LLATION /3 6 ,7 & 9�C
�►J
Owner's Name: J,C45fF2 C� / C7E' n,,'r/,}} Telephone. Zle 6 4�4 1417f/
Address: /9 6 T ee l 94 � L, " hd,. r �J� 6 L' ll�f C�Et?+PG1` /% 4A �
Installer's Name: 49urtrOVS )3el4e ' Telephone: � 732 - 349 t '
Number of bedrooms (residential only)
Total daily flow (compute (a ISO gal per bedroom) oil &
Topography: Circle on Flat Rolling Steep Slope % of Slope
Soil Nature: Circle on • an Loam Clay Other /Depth: Feet
Ground Water. At what depth? /4 Feet
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle on ` of require required rate min. inch.
Domestic water supply: circle one: Municipa Well Other
If domestic water supply is a well: y feet y4 �,�IGc,J "rf�//�� �_y� //
'Separation: Water supply from septic absorption
PROPOSED SYSTEM : Septic Tank ZOO & gal. (minimum size: 1 . 000 gal.)
TILE FIELD: Each 'french feet/Total system length feet
SEEPAGE PIT(S): Number of / / Size each feet by feet
Size of stone to be used #ly A /Depth or Thickness NWOY feet Wd R'L` N G
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 Rueensbury Sanitary Sewage Disposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:�7
DATE. /.' s/
OVER
,� ' R1 d
.' -
Septic 5 stem Ins ections :
A • All applications for septic system installation , alteration o repair ,
as required by the Town of Queensbury Sanitary Sewage or
Of
be submitted to the Building De R
b 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 ,
tile fields and /or drywells
1, 13 • No system shall be covered before inspection and approval 6y the
J3uilding Inspector . Failure to comply with this requirement may
rusult in the uncovering; of the system by the installer and a fine
ut 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
he submitted to the Queensbury Building Department before further
construction .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
f1v [f 1:lrks ;
S h' F
k5u BUILDING and ZONING DEPARTMENT
D Bay and Haviland Road, R. D. 1 Sox 98
Queensbury, New York 12801
SEPTIC DISPOSAL_ SYSTEM INSPECTION
NAME Oat 4mot �1
LOCATION 6 7 ..4>F. r e...
DATE f� /�7PERMIT NO .,_ /
SOIL TYPE Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSPMOC
Absorpt field , total ng ►
Len of each tre
th of trenc
Size of gr - —
SEEPAGE Ts4Number of)
size- ft. X _- �� ft .le
G el size
IPING : size Type
Bldg . to tank
Tank to diet . boX
Lust. bOX to feel L` rt{,GifS
Openings sealed? ES No Partial
LOCATION/sEPA TIONS :
Foundation t tank j "z--f t.
Foundation absorption k� �T1r
Absorption o lot line f
Separation of pits f
LOCATION SYSTEM ON PROP RTY circle one)
Front - ar W Left side. - ght side -
CfJb94VNTS
SYSTEM. USE APPROVED N
uildi g speotor
01/86 and vl
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