1989-842 BUILDING PERMIT
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TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK No. _ F'4_FZ47
PERMISSION is hereby granted to +—
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OWNER of property located at f uzarno Rel & Twj n Mtn nri vp Street, Road or Ave. �
to
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in the Town of Queensbury, To Construct or place a Sewage AltPratinnry
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
RD #2 - Sox 338
Luzerne Road
2_ CONTRACTOR or BUI LbE R Name rn
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ACTION SEPTIC -mac
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3_ CONTRACTOR or BUILDERS Address �
d. ARCHITECT'S Name
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6. ARCHITECT'S Address
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6. TYPE of Construction — (Please indicate by X)
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( } Wood Frame ( ) Masonry ( ) SteelCL
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7. PLANS and Specifications fr+
No. Existing 1000 gal . tank ; 200 ' trench system as per application
and plotplan ,
S. Proposed Use t-I
Sewage Alteration ,
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$ 25-9 Q1L] PERMIT FEE PAID — TEAS PERMIT EXPIRES �ddOctober 26 1991
{lf a longer period is required an application for an extension must be made to the Building and Zoning inspector of xhe
town of Queensbury before the expiration date.! rrt
a
Dated at the Town of Queensburythis r' r
Day of October
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SIGNED BY for the Town of Queensbury .rom
Building and Zoning rhipector A
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TOWN WN OF Q UEENSB UR Y A� 0
APPLICATTON FOR TOWN OF QUEENSBURY
RECEIVED
SEPTIC DISPOSAL PERMIT
OCT 2 6 196q
yj BLDG* & CODE DEPT.
DATE
LOCATION OF PROPERTY FOR IN
ST L+yoL�Ay-TION �!, r �y �r/ ?r � r .r w �'✓
Owner's Name: rj! Telephone: `
Address:
Installer's Name: -"' "
Telephone:
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 on . 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 one: Nluniicipal Well father
If domestic water supply is a wel
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank L gal. ( minimum size: 1 , 000 gal.)
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of / Size each feet by feet
Size of stone to be used /Depth or Thickness ! 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 n ` ary ewagey3isposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
DATE :
OVER
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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 . ) tk-ke 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 ,
file fields and / or drywells
B3 No system shall be covered before inspection and approval by the
Building lnspuctor . 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
situ . Failure to produce said plat plan at time of inspection may
result in an immediate work stoppage .
D . Should unforeseen problems during construction prevent proper i.nstalla—
tion , alteration or repair of an approved system , a new proposal must
Ile submitted to the Queensbury Building Department before further
coOstruetion .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York. 12804
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BUILDING and{ZONING DEPARTMENT
Bay and Haviiand Road, R. D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCAT I ON
DATE /� PERMIT NO .
SOIL TYPE `clay , .
Percolation Test`',Requ1red? YES _, O
Percolation rate Minfxnch
TYPE of SYSTEM : f'
Absorption field , total leng
Length of each trench
Depth of trenches - , #
Size of gravel T`
SEEPAGE TITS{Numb r• nf}
Size- _�-�E�~x f
Gravel size
PIPING : Size T'Y.Pe
Bldg . to tank f r: , � i
Tank to mist _ box L� � ' A ,
Dist . boy. to fief / r
Openings Sealed? YES NO Tartial
LOCATIONfSEPAR.A�15IONSe
Foundation to lank ft,
Foundation to abscrptl,on £t .
Absorption to; lot line TCircle
Separation of pits
LOCATION OF SYSTEM ON PROPERT one)
Front -/Fte P �ft 5l - Right side -
COMMENT
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SYSTEM USE APPROVED YES qA,
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