1989-894 G( BUILDING PERMIT
TOWN OF +QUIEENSBURY
WARREN COUNTY, NEW YORK No. �xg sz>aa
PERMISSION is hereby granted tyt DANIEL DRELLOS *
OWNER of property located at N o r t h w i nds Mobile Park if 31 & 30 Street, Road or Ave, i'
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in the Town of Queensbury, To Construct or place a CawagQ A l tpratjpn
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 Oueensbury Building and Zoning Ordinance.
t. OWNER'S Address is
PO BOX 224
Glens Falls
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2. CONTRACTOR Or BUILDER'S Name m
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
S. ARCHITECT'S Address �
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6, TYPE of Construction — (Please indicate by X) C
tfY
I ) Wood Frame I ) Masonry 1 ) Steel
7. PLANS and Specifications no
No. Existing XXX 1 000
gal tank with two b ' x B ' seepage pits
as r i ti n d submitted plans
$. Proposed use
Sewage Alteration
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5 00 PERMIT FEE PAID — THIS PERMIT EXPIRES .—�1Vo�tembfsr 9 , _ 1S�L_ in
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the A
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this Q:Lh pay of ,er
SIGNED BY for the Town of O ueensbury
Building end ,Zoning inspector
f OWN OF QUEENSBURY
APPLICATION FOR 'J f
fry- .'�`'= 4 If f �.; �=� W
--vim SEPTIC DISPOSAL PERII+IIT R�CEtf tpV's fRa
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OV 8
1989
BATE I ( 1 C0 4e
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LOCATION OF PROPERTY FOR INSTALLATION ,IU�r� r,�, , ,y � f` / L7 ��.;
Owner's Nameh 1111111" r (' , / [/OJ Telephone—:
Address:
Installer's Name: � '�+)^r ,:3 r{ ,,, Telephone: `7 qy
Number of bedrooms (residential only) �
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Total daily flow (compute (d 150 gal per bedroom ) j00</f /f
Topography: Circle one: Flat Rolling Steep Slope % of Slope 611
Soil Nature: Circle one: Sand 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: unicip Well Other
If domestic water supply is a we
Separation: Water supply from septic absorption - feet
PROPOSED SYSTEM: Septic Tank WO 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 this sheet and a r e to abide by these
and all requirements of the Town of Quee ur nitary Sewa D ' sal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
DATE:
OVER
Septic System Inspections :
Aw 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 plat 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 dimznsions of all tanks , distribution boxes ,
file fields and / or drywells
B . 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
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 installs--
tian , alteration or repair of an approved system , a new proposal must
bu submitted to the Queensbury Building Department before further
construction .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Stay and Haviland Roads
Queensbury , New York 12804
Remarks :
_Dawn a/ Queen36ury X
BUILDING and ZONING DEPARTMENT / f
Bay and Haviland Road, R. D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME1� '� rf X l .�7ic7f
LOCATION 7 ...Sg x r�
DATE _1 PERMIT NO .
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM :
Absorption field , total length
Length of each trench
Depth of trenches .
Size of gravel
SEEPAGE ;? ITs4Number of)
Size- __ft, x ft.
Gravel size -
PIPING : Size Type
Bldg . to tank
Tank to list. box
Dist . boy_ to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS :
Foundation to tank ft.
Foundation to abscrption ft .
Absorption to lot line ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY (cirele one )
Front - Rear - Left side - Right side -
COMMENTS :
SYSTEM USE APPROVED ' YES O
Bu ing inspector
01/86 and vl
�C7GVI't L!� �IfFFI73G74lM1t Y
BU(LDIN+G and ZONING DE PARTMaEEWfM
Bay and Hawiland Road. R. D. I Box 98
Queensbury, New York 12801 C�
SEPTIC DISPOSAL SYSTEM INSPECTION
MIME { �e�??
LOCAT I OPi +r77" �C
DATE *!' / PERMIT NO.
SOIL TYPE"- Sand - Loam - Clay
Percolation Test Required? YEy4"- NO
Percolation rate - Min/Inch
i
TYPE of SYSTEM :
Absorptlon field , total l"gth
Length of each trench_
Depth of trenches_'
Sloe of gravel_
SEEPAGE/�?STS{Nuinbe p --
Size- �r ft. X t .
Gravel si ----
PIPING : Size Type
Bldg . to to k �
Tank to ciis
Distw bo,s: to f - Id/pit
Openings seal ? ES NO Partial
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LOCATION/SEP IONS : , J
Foundation o t k -
Foundation to ab rption ft"j
Absorptio to lot ine Y
t.
Separati of pats t.
LOCATION OF SYSTEM PROPERTY (circle one )
Front - ear - Left ide - Right side
C CHMEN +
SYSTEM USE APPROVED Agri
Builpector
01/86 and vl