1989-825 BUILDING PERMIT X
TOWN OF +QUEENSBURY No. 89-825
WARREN COUNTYr NEW YORK : .
PERMISSION is hereby granted tol, WIL IAM LAV RY `_'
OWNER of property located at 39 Wintergreen Rd Street, Road or Ave. r:7
in the Town of Queensbury, To Construct or place a Sewage 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.
1 . OWNER'S Address is
SAME
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2. CONTRACTOR or BUILDER'S Name r—
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Sanitary Sewer
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3. CONTRACTOR or BUILDER'S Address r*t
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4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction — (Please indicate by XI r+
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{ ) Wood Frame ( 1 Masonry ( 1 Steel 1 1 m
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7. PLANS and Specifications .�
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No. Existing tanks 40 ' trench as per application and plot plan . -
8, Proposed Use
Sewage Alteration
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$ 25 00 PERMIT FEE PAID — THIS PERMIT EXPIRES October 24s 1991
(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 dare_) A
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Dated at the Town of Queensbury this^ . 94th Day of 0 tnb@r 19JI9 — �a
SIGNED BY for the Town of Queensbury ZE
Building and Zo inspector
TOWN OF QUEENSIB LTRY
APPLICATION FOR
sjEpTIc DISPOSAL PERMIT
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DATE, 10 j do,00",
DATE ODDS
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LOCATION OF PROPERTY FOR INSTALLATION
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Owner's Name: 11(1111111111111111!!�, Telephone* 7K7 0Z
AddreSS: 3q
Installer's Name:d X640fN I Telephone:.---7-'T 20 !926�Z
Number of bedrooms (residential only) •?
Total daily flow (compute (d 150 gal per bedroom)
Topography. Circle one: la I Rolling Steep Slope % Of Slope
Soil Nature: Circle one: an Loam Clay Other /Depth:.Feet
Ground Water: At what depth ? Feet
Bedrock or Impervious Material. At what depth? Feet
Percolation test* Circle one: not required) required rate min. inch.
Domestic water supply: circle one: unielpa Well Other
If domestic water supply is a well:a
Separation: Water supply from septic absorption feet
PROPOSED SYSTEMP Septic Tank &1j.7"r-j gal. (minimum size& 1 -.000 gal.)
TILE FIELD: Each Trench ,40 feet/Total system length feet
SEEPAGE PIT(S): Number of Size each feet by feet
Size of stone to be used #,,a./Depth or Thickness. feet
I have read the regulation on the reverse Q side is sheet and agree bide by these
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and all requirements of the Town of r U S itary Se%Pvag D sposa Ordinance*
SIGNATURE OF RESPONSIBLE PERSONe.7!
DATE* 9
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 CO any water supply
5 . ) size and dimensions of all tanks , distribution boxes ,
rile fields and /or drywells
b • No system shall be covered before inspection and approval by the
Building ljnspuctor . Failure to comply with this requirement may
result in the uncovering; of the system by the Installer and a fine
of up to $ 250 . 004
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
rosult 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 dust
tau submitted CO the Queensbury Building Department before further
LOOS t ruct ion .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Naviland Roads
Queensbury , New York 12$04
Kuma r ks
BUILDING and ZONIICNG DEPARTMENT
Say and Havikand Road, R .D. 1 Sox 98
Oueensbury. New York 12801
SEPT.IFC DI5POSAL SYSTEMS INSPECTION
NAME". � I/�'+ ��-i--
LOCAT I Opt �"' T _
i7ATE I� �IS _ PERMIT NO . c
SOIL TYPE - Sand - Loam - C)'ay
YES - NO
Percolation Test Required?
Percolation rate - Min/Inc} -
TYPE of SYSTEM: 2A%9
Absorption field , total ength
Length of each trench '�
Depth of trenches
,,_:_
Size of c1ravel
SEEPAGE ioITS-4i3uinber Of
Size- ..ft. X _ f
Gravel Size
PIPING : Size 'IYFe
Bldg . to tank ■ --
Tank to t1ist. box
Dist . bos: to field
Openings sealed? ES No Partial
L OCAT ION J'SEPARATI S .0
?
Foundation to t
r ft.
Foundation to ab crptionf �-ft .
Absorption to 1 line
Separation of PX"ts
ft.
LACATION1 1tSTEM PROP TY (circle one]
Front - ear - Left side - ght side
CCNIMENTS
SYSTEM USE APPROVAxid
NO
Inspector
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