1989-777 BUILDINGPERMIT
TOWN OF QUEENSBURY No. 89-777 --
WARREN COUNTY, NEW YORK r
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RMISSIQN is hereby granted to William Smith
OWNER of property located at a-r annirocon Road 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. OWNE WS Address is
Same
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2. CONTRACTOR or BUI LDEWS Name
Same
3. CONTRACTOR or BUILDEWS Address �
Same
4. ARCHITECT'S Name
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5, ARCHITECT'S Address o
X
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6. TYPE of Construction — (Please indicate by X) C
l ) Wood 'Frame 1 1 Masonry 11 Steel ( 1 0
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7. PLANS and Specifications m
No. 1000 gal . tank , 200 ' the field as per plot plan and application * o
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S. Proposed Use
Sewage Alteration
$ _r on n PERMIT FEE PAID — THIS PERMIT EXPIRES September 29 19 91 co�
fit a longer period is required an application for an extension must be made to the Building and Zoning inspector of the :E
town of Queensbury before the expiration date_} un
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Dated at the Town of Queensbury this 99t_h Day of September 19 89
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SIGNED BY lcra C+G� for the Town of Queensbury
Building and Zoning I nspecto G}
TOWN OF QUEENSBURY
APPLICATION FOR
SEPTIC DISPOSAL PERMIT \7`C7wNiV RE Qi.# D 5g P�.
SEP
DATE f I� t ;� ` BLDG. & CODE DEPT,
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: 1 t`/ Telephone:
'Ala
Address: Q X
Installer's Name Telephone:
Number of bedrooms (residential only)
Total daily flow (compute (d 150 gal per bedroom)
Topography: Circle one: tat Roiling Steep Slope % of Slope
Soil Nature: Circle one Loam Clay Other /Depth: Feet
Ground Water: At what depth? I Feet
Bedrock or Impervious Material: At what depth ? Feet
Percolation test: Circle one not require duired rate min. inch.
Domestic water supply: circle one 'TVlunicipa Well Other
If domestic water supply is a welli feet
Separation: Water supply from septic absorption
PROPOSED SYSTEM -& Septic Tank k/�t . gal. ( minimum size: 1 , 00C1 gal.)
TILE FIELD: Each Trench feet /Total system length ;&QQ feet
SEEPAGE PIT(S): Number of .i / Size each " feet by feet
Size of stone to be used # _/Depth or Thickness_
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 Sanitary Sewage Disposal Ordinance.
SIGNATURE OF RESPONSIBLE' PERSON._ l/,c.GCt� r ra'• ''
DATE:� Jd]
OVER
SepCiC 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 th9,,J$u"ding,wDapartment at least 24 hours before start
of constructionand 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 and /or 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 uncovering of the system by the installer and a fine
cif 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 Co the Queensbury Building Department before further
Quu trucc icil .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
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4.Jaeare o� �rseenshur� � � `Z
BUILDING and ZONING 0EP'+ARTMENT ,�-'') ,✓y,
Bay and Haviland Road, R-D. 1 Box 9�8 d�� G
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
LOCAT ION2� � J S� u't J'J �Yt ids' c
DATE �f"i' PERM IT NO.
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch _
TYPE of SYSTEM:
Absorption field , ;total lien -
Length of each trer'*qh
Depth of trenches
Size of gravel
SEEPAGE PITS4Number of
Size- ft. X _ ft.
Gravel size
PIPING : S '
Bldgo to tams
Tanis to dist. boas
Dist. box to field/p
openings sealed? NO A � rtial
LOCATION/SEPARATION
Foundation to tank. *ff
t-
Foundation to abs ptiont .
Absorption to to lineto
Separation pi s to
LOCATION S S ON PROPERTY (circle one )
Front - ear eft side - Right side COMMENT
SYSTEM USE APPROVED4YESO
Hui d ng Inspector,
01/86 and vl
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