1989-745 w
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BUILDING PERMIT
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TOWN OF QUEENSBURY No. 89_745
WARREN COUNTY, NEW YORK t
�, � �' 1 • Northwinds Mobile Park u�
PE R M I SSION is hereby granted to
Lots 48 & 49 Street, Road or Ave.
OWNER of property located at
Sewage Alteration
in the Town of Queensbury, To Construct or place a
at the above location in accordance to application together with plot plans and other information hereto filed an
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OwNER"S Address is
P . 0 . Box 224 �
Queensbury P1 . Y , 12$04
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2. CONTRACTOR or BU1 LDER"S Name
t->
Self
3. CONTRACTOR or BUILOER•'S Address
Same
4_ ARCHITECT'S Name r'
C
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cr
or
5. ARCHITECT'S Address '
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6. TYPE of Construction — (Please Indicate by X1
{ y wood Frame { I Masonry { ) Steel { ?
7. PLANS and Specifications its as per plot plan , and appl ci a ion .
No. 1000 gal , tank : 2 6 ' x 8 ' seepage p
S. Proposed Use K
Sewage Alteration
91
$ 35 . C1C1 PERMIT FEE PAID — THIS PERMIT EXPIRES
September 19 Ir is
oning impactor of the
{If a longer par dad is required an appiicat ion for an extension must be made to t h a Building and Z
town of ousensbury before the expiration date.)
Dated at the Town of Oueensbury this —
Day of �s 89
/* for the Town of Queenshury
SIGNED BY Buy Ong and Zo lr�spector
rotivrr aruEcNsUr t
APPLICATION FOR °I-O*/af 4 Or—
SEPTIC DISPOSAL PERMIT SEP
Yyz f
& CODE DEPT.
DATE L r
'' ' L .
LOCATION C<E�pROPERTY FOR NST/ALLATION
/ (^ �G dux' Telephone:
r
Owne 's Name-, _ ig_�
Address: - "
_�, . ✓� Telephone:
Installer's Name: .r�1
Number of bedrooms (residential only)_/
Total daily flow (compute (d 150 gal per bedroom)
Topography: Circle one: Flat Rolling Steep Slope % of Slope
Soil Nature: Circle one Sand Loam Clay Other IDepth:
Feet
Ground Water: At what depth? �^ Feet
Bedrock or Impervious Alaterial: At what depth? Feet
Percolation test: Circle one: of require equired rate min. inch.
Domestic water Supply: circle one: unici Well Other
If domestic water supply is a wel : feet
Separation: Water supply from septic absorption
PROPOSED SYSTEM : Septic Tank ( �'� gal. ( minimum size: 1 . 000 gal.)
TILE FIELD : Each Trench feet/Total system length
feet
SEEPAGE PIT(S): Number of Size each . Meet
�feet b y
Size of stone to be used # !Depth or Thickness
feet
** *************** *** **** *
i have read the regulation on the reverse a of thi sheet and afire abide by
these
and all requirements of the Town of Glue nsbu San tary Sewa is go al Ordinance.
SIGNATURE OF RESPONSIBLE PERSON :
DATE; '
71/ of 0 V E R � /
Septic System Inspections :
A * All applications for septic system installation , alteration or repair ,
as required by the Town of Queensbury Sanitary be submitted to the Sewage Ordinance , shall
Building Department at least 24 hours before start
of construction and skull include a Plot ,Plan showing :
1 • ) rile pronosod location of the system
location and distance to lot lines
� . ) 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 drywells
B • No system shall be coverad before .inspection and approval by the
isuilding Inspector . Failure to comply with thi
result in tree uncovering of the system s requirement may
up to $ -'' 50 . 00 . by the installer and a fine
of
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 Queonsbury Building Department before further
construction .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Eiaviland Roads
Queensbury , New York 12804
i•:4m.:� rka
._.J'own o� �ueeri3hurt�t
BUILDING and ZONING DEPARTMENT
Bay and Havikand Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC D I SPOSALL 5YSTEM IINSPECTION
NAME
LOCAT I �, J
DATE �f �� fPERMIT NO ._�
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch -
TYPE of SYS i
Absorption f ld , total lengt�
Length of each trench
Depth of trenches
size of gravel_
SEEPAGE P TS-(Number ) -
Size- kA X t. _
Gravel size
PIPING : Size Type
Bldg _ to tank
Tank to dist. box
Dist. box to f iel Pit
Openings sealed? YEE� NO Partial
t
LOCATION/SEPARA IONS :
Foundation to ank ft-
Foundation to bsorption L ft .
Absorption t lot line ft•
Separation o pits ft-
LOCATION OF SYSTEM ON PROPERTY (circle one)
Front - Re - Left side - Right side -
CCOOIENTS :
7 , 1711
SYSTEM USE APPROVED YES 10
Building I spedtor
01/86 and vl