1989-798 x
BUILDING PERMIT
TOWN OF QUEENSBURY
No. s�Q-7aR-74R
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WARREN COiUNTY, NEW YORK
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PERMISSION is hereby granted to
Street, Road or Ave,
OWNER of property located at A 1 uZernp Road
Siewag
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 and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance_
t. OWNER'S Address is
Sesame
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2. CONTRACTOR or BUILDER 'S Name .-
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9XMINK Smith Excavating
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address N
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6, TYPE of Construction — (Please indicate by X3
t } wood Frame i ) Masonry i t steal l }
7. PLANS and Specifications
No. 1000 gal . tank , 1 10 ' x 8 ' seepage pit as per plot plan and applicati n .
8. Proposed Use
Sewage Alteration
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$ 25 00 PERMIT FEE PAID - THIS PERMIT EXPIRES K
P�1a�G 1 fg—��— nCID
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the -f
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town of Queansbury before the expiration date.) r
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Dated at the Town of Queensbury this 191h Day of OCtOber�Sg�9--- R
�, for the Town of Queensbury
SIGNED BY g�in9 and_�cmng Inspector
TOWN OF QUE•EENSBURY f
APPLICATION FOR
SEP71C DISPOSAL PERMIT
DATE
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name* I; E, f/11S� rC _ y Telephone: %� C1
Address: 14 r � v�o r'3 Owl'
Installer's Name: �� ,+�--� � � � -� i ��,� Telephone:
4 l
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Number of bedrooms (residential only) 4
Total daily flow (compute Cd 150 gal per bedroom)
Topography: Circle one: Rolling Steep Slope 9h of Slope
Soil Nature: Circle one nd Loam Clay Other /Depth: Feet
Ground Water: At what depth ? vx� Feet
Bedrock or Impervious Material, At what depth ? � Feet
Percolation test : Circle one: not required required rate ;x min . inch .
Domestic water supply: circle one: Municipal Well Other
If domestic water supply is a welt:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank ,,/0do gal. ( minimum size: 1 , 000 gal.)
TILE FIELD: Each 'Trench � feet/Total system length feet
SEEPAGE PITS): Number of / Size each fbI feet by
,feet
Size of stone to be used # /Depth or Thickness^ 40f 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 anitary Sewage Disposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON :
DATE:
OVER
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Septic System Inspections : 10
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 houra before start
of construction and shall include a plot plan showing :
1 . ) the proposed location of the system
7 . ) 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 and /or drywells
Ii . No system shall be covered before inspection and approval by the
building Inspector . Failure to comply with this requirement may
result in the uncovering of the: system by the installer and a fine
ut up to $ 2150 . 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 instaila.
tion , alteration or repair of an approved system , a new proposal must
be submitted to the Qut- ansbury Building Department before further
cox: ;; truct : on .
Town of Queensbury
BUILDINC and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
k:�xu:xr �: s
_Jow" of Queenji " ry
BUILDING and ZONING 17EPARTMENT '
Bay and Haviland Road. R .0 , i Sox 98
Clueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAJ ME
LOCAT,I O/NI,
DATE !U/ PERMIT NO
SCTL TYPE - nd - Loam - Clay - sr
percolation Te t Required? YES /- NO
percolation rat - Min/Inch �
TYPE Of SYSTEM; tal length
Absorption field ,
Length of each tren
Depth of trenches
size of 13ravel �--�—
SEEPAGE ,DlTS- Nurrt37eLr! ft �4
Size- �ft . X
Gravel size S ze Type
PIPING : � yF
bldg. to tank
Tank to t1ist . box
Dist _ b03: to Aield/ Partial
Openings seaAed? YES
L,or-PLTION/'S ARATIONS
ft.
Foundatic, to tank �ft .
Foundatic to abscrptiQn t.
Absorpti n tc3 lot line
ts t
Separat ' n of 3. M ON PROPE circle one )
Y Qn - Right side -
Front
L- ear eft side 9
COMMENT
SYSTEM USE APPROVED E
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Buii$i Ins ctor
01/86 and vl
Clemente
Latham North
Reed Street
Glens Falls, New York 128G1
518-792-3502
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