1989-756 s�
BUILDING PERMIT "
TOWN OF QUEENSBURY No. RQ_ 75A
WARREN COUNTY, NEW YORRK
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PERMISSION is hereby granted to
OWNER of property located at "T _ � Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Sp wage A l to ra t i nn
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 G7
RD#1 Box 1107 0
Lake George , N a Y e 12845
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2. CONTRACTOR or BUILDER 'S Name
rr
Self -�
3. CONTRACTOR or BUILDER 'S Address
Same
4_ ARCHITECT'S Name
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5. ARCHITECT'S Address
C7'
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6. TYPE of Construction — (Please indicate by XI
ah
S ) Wood Frame i 1 Masonry 11 Steel f 1
7. PLAINS and Specifications
No. 1000 gal tank , 1 10 ' x 12 ' Seepage Pit as per plot plan , XXXXXICXX
and applicationa
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8. Proposed Use �
Sewage Alteration m
x
m
$ 0(? PERMIT FEE PAID — THIS PERMIT EXPIRES _ Septe iher 22. 19 91
(lf a longer period isrequlred an appIionion for an extension must be made to the Building and Zoning inspector of the
town of Queansbury before the expiration date.)
Dated at the Town of Queensbu7Z8
22nd D of 5e�stember 19 89
SIGNED BY for the Town of Queensbury
lding and Z irxd 1 nspector
TOWN OF QUEENSBURY
. -�. � . APPLICATION FOR S RfiLC �^iGrgr
-� ;A
SEPTIC DISPOSAL PERMIT eC I
r}
DATE //3•
LOCATION OF PRO ERTY FOR INSTALLATION
Owner's Name: _ Telephone:
Address: I'l b `/'' 6,9,K 11,0 7 LX ex ee1,.-b. t�rt',` Z249 y'
Installer's Name: Telephone:
Number of bedrooms (residential only) or
� ,�
Total daily flow (compute Cd 150 gal per bedroom? /7( C'�--'X J� " O /
Topography: Circle one: Fiat Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand Loam Clay Other /Depth: Feet
r
Ground Water: At what depth:' 0V4FR � '� Feet
Bedrock or Impervious Material: At what depth? C)k( Feet
Percolation test: Circle one: not required 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 Tank Looc>._gal. ( minimum size: 1 .000 gal.)
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of / Size each -feet by jj
_feet
Y
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 Sa tary Sewage Disposal Ordinance.
SIGNATURE OF RESPONSIBLE^ PERSON:
DATE : G.)/,e de �-�-- -
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 ,
the fields andYor drywells
B . No :system shall be covered before inspection and approval by the
Building Inspector . Failure to comply with this requirement may
result in the uncoverinb 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
be submitted to the Queensbury Building Department before further
construction .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Say and Haviland Roads
Queensbury , New York 12804
kuma rk.s :
of Q"Iev" 614"Iry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, 91). 1 Bax 'B
pueensbury, New York 12801
SEPTIC plSMSAL SYSTEM INSPECTION
- 7 r 7 1,}
NF�1EIII
LOCATION
DATEZQ*/S! PERMIT NUJ .
SCSL 'TYPE - Sand oa clay
Percolation Test Required? XES -(r-
Percol tion rate Min/Inch
TI Of sYSTEM9* e ,
Absorption f iel trench
Length o
D of trenches
Size of - --�-�--
SEEPAGTS Et3vmber o£) O
size-
ft. X ft. .
Gravel size 1ze Types
P IP ING : C--
Bldg . to tank '
Tank to dist . box
Dist. box to field/ a Np � Partial
openings sealed' E
Z,OCATIDtd/SEFARA't S : . �L' 3f t.
k �XtS:r
Foundation to t o tionR ft`
Foundation to a s rI� ft .
Absorption to t line ftIts .
Separation of STEM OI3 PROP R e one)
ION ce S �
rron - Rear - Left side - igTxlt
CbMMEN'TS =
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AAL
5Y STF24 USE APPROK7E
p YES )d4
Building Insp for
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(.. 30 t7
_burn of Queen31" ry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D, 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCAT I ONI
r
DATE 1-1-� PERMIT NO .�"
SOIL TYPE - and - Loam - Clay
Percolation est Requir ? YES NO
Percolation r to - Min/inch -
TYPE of SYSTEM=
Absorption fiel total leng
Length of each ench
Depth of trenches
Size of +Iravel�
SEEPAGE ;SITS-(Numbe
Size- �t . X b t .
Gravel size
PIPING : S ze Type
Bldg . to tank
Tank to dust . box - --- c -
3c11
Dist , bos; to field/p ' S O -- Partial
Openings sealed?
LOCp4TI0N/'SEPA'RATIO f t.
Foundation to tank £t_
Foundation to abs r tion
€t _
Absorption to to line t.
Separation of pi S
LOCATION OF SYS ON PROPERTY ircle one)
Front - Rear - eft side - Right Side -
CClyEI3TS : '4pAaer1 r�
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c11 Ly / LS � , t i
SYSTEM USE APPROVE4d :iLn
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