1989-826 BUILDING PERMIT -I
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TOWN OF QUEENSBUR'Y' No 82-826
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PERMISSION is hereby granted to T4NY DeMATTOS
OWNER of property located at _ 6 Gilmore Avenue Street, Road or Ave.
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in the Town of Cueensbury, 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.
1 . OWNER'S Address is
SAME
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2. CONTRACTOR or BUILDER'S Name
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Sanitary Sewer ig
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3. CONTRACTOR or BUILDERS Address
4. ARCHITECVS Name
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S. ARCHITECT'S Address
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B. TYPE of Construction — IPlease indicate by xl m
{ ) Wood Frame { ) Masonry { I Steel { ) rn
7. PLANS and Specifications
No. Existing tank , 3 6 ' x 8 ' seepage pits as per application
and plot plan .
B. Proposed Use
Sewage Alteration .
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$ ?5 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES October 24 1991
IIf 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 date.? rn
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Dated at the Town of Queensbury this 24th Clay of October 19 89 .
SIGNED BY cza ,� for the Town of Queensbury ZE
Building and Zonirig I nspector
TOWN OF QUEENSSURY
APPLICATION FOR
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v SEPTIC DISPQSALw ti. ,,. PERMIT IysS
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TO �p �`-:� fir`{ � .�>� � S1 � ���
DATE / C./ "" ! Q REV1i Wtili3 u'f � . 0 r
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DA � a.
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LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: /� /C1r c1/ / '/MJ TelepFrane:
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Address: ,r s-�
Installer's Name: Gc�- Telephone: / �.� ` ,4o2 cS
Number of bedrooms (residential only)
Total daily flow (compute Ca 150 gal per bedroom) 6 0 +%
Topography: Circle on Flat Rolling Steep Slope % of Slope
Soil Nature: Circle one: and 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 on : unici al Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM: Septic Tank ( ,(, gal. { minimum size: 1 .00n gal.)
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of / Size each feet by JDr feet
Size of stone to be used # /Depth or Thickness 2L 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 Queen ry anitary S ge isposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
DATEO
OVER
1
Septic . 5 stem Inspections :
A , All applications for septic system installation , alteration or repair ,
as required •b'y the Town of Queensbury Sanitary Sewage Ordinance , shall
be submitted to the Building Department at least 24 hours before start
of coristr%ction and shall include a plot plan showing :
I * ) 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 ,
rile fields and / or drywells
B . Nu System shall be covered before inspection and approval by the
building Inspuctor . Failure to comply with this requirement may
result in the uncovering of the system by the installer and a fine
of 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
hu submitted to the Qut�cnsbury Building Department before further
construction ,
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
K`n�arks
au.n of
ueensEsu►'� le-� '
BU4l.l7fNG and ZONING r)EPARTMENT
Bay and Haviland Road. R .D . 1 Box 98
Cpueensbury, Nevi+ York 12801
SEPTIC DISPOSAL SYSTEM INSPECTIO7 y;
1 `3
NAME
LOCAT I ''
Il
e�/ PERMIT NO .
PATE
SOIL TYPE sand - Loam - Clay N r----
percolation Test Required? YES
Percolation rate - Min/inch -
TYPE of SYSTI
p,b_ oxp
tion fi Id , total length
Length of each trench
Depth of trench s
Size of ;xave1, of}
SEEPAGE -TTS4 f)
size_ ft . }C
Gravel size 2e . ype
PIPING :
Bldg * to tank
Tank to ciist . box `---_
Dist . bm to f field/ NO Partial
Openings sealed? S
LOCATl013/0SE'PARRT
Foundation to t k
scrption to
Foundation to t .
Absorption to of to �t.
Separation Of pits circle one)
Z >CATION C?F STTc34 ON PROPERTY {
Front - ar
Left side - Fright side -
COMMENT Je
SYSTEM! USE APPROVED f YES
Building -inspector
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