1989-893 BUILDING PERMIT
A
TOWN OF +QUEENSBUR`1t' No. €39-833 x
WARREN COUNTY, NEW YORK
PERMISSION iis� hereby gran t DAN DRELLOS
OWNER of property I� at Northwi nds Mobile Park # 11 &12 Street, Road or Ave.
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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 Oueensbury Building and Zoning Ordinance.
t . OWNER'S Address is
PO Box 224
Glens Falls o
2. CONTRACTOR or BUILDER'S Name 70
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Sanitary Sewer
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3. CONTRACTOR or B ILDEWS Address Q
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x
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4. ARCHITECT'S Name
5. ARCHITECT'S Address
x
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G. TYPE of Construction — (Please indicate by X)
{ ) Wood Frame { ) Masonry { I Steel { )
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7_ PLANS and Specifications
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No. Existing 1000 gal tank with two 6 ' x 8 ' seepage pits as per application
$. Proposed Use MIS
Sewage Alteration . "'T
$ 35 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES November cl 19 41___ m
(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 data.) K M
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Dated at the Town of Queensbury this Day of November 1s._..�2 K m
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SIGNED BY / for the Town of Queensbury
Building and Zom 1 nspector
1"OWN OF QUEENSBURY 4P
_ APPLICATION FOR
SEPTIC DigpOSAL PERMIT OF QuEENSB�R
T0W I`� VIEGEIV ED
typv 8 1gB9
DATE / -' ' r ' -- V3 G , & caDE
s <a.-
LOCATION OF OPERTY R INSTALLATION / � ' + � � f
Owner's Name: b Telephone:
CieAddress
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 one: Sand Loam Clay Other -�� /Depth:i _ Feet
Ground Water: At what depth? —�" Feet
Bedrock or Impervious Material: At what depth:' — f Feet
Percolation test: Circle one: not required required rate min. inch.
Domestic water supply: circle one< N1untci ,t�l Well Other
If domestic water supply is a wel : feet
Separation: Water supply from septic absorption
PROPOSED SYSTEM : Septic Tank gal. ( minimum size : L . gO () gala
y g --
TILE FIELDS Each Trench � feet /Totals stem length feet
SEEPAGE PITS?: Number of �2,_I Size each 6 feet by
feet
Size of stone to be used /Depth or 'Thickness
�-• feet
I have read the regulation on the reverse 2oth sheet and agr abide in these
and ail requirements of the Town of Queensa itary Sewa D' p al Ord' a ce.
SIGNATURE OF SPO SIH1.E PERSON*
7
BATE:
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 to any water supply
5 . ) size and dimensions of all tanks , distribution boxes ,
cilia fields and / or drywells
B . No system shall be covered before inspection and approval by the
building Inspuccor . Failure to comply with this requirement may
result in the uncovering; of the system by the installer and a fine
ut up to $ 250 * 0 0 ,
co 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
bu submitted to the Queensbury Building; Department before further
construction .
Town of Queensbury
BUILDTNG and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury . New York 12804
h�m;srks
_Jorwn o/ Queen31"ry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road. R.D. 1 Box 98
Oueensbury, New York 12801
SEPTIC/ DISPOSAL SYSTEM ,I/N�S, PE TION ,r
NAME 171erl7AV14 —!
LOCAT II O/N/DATE f 0 j+
/f PERMIT NO . I
SOIL TYPE - . an - Loam - clay -
Percolatio st Required? YES - NO
Percolation rate - Min/Inch ,
TYPE of -SYSTEM :
Absorption f! ld , total length
Length of each trench
Depth of trenc es '
Size of .Xravel _ ---
SEEPAGE a31TS4N £ ) _
Size- ft. X !, CJ tt. '
Gravel size
PIPING : Siz f Type ,��
Bldg .5 to tank/
Tank to ciist. box
Dist. boa: to field
Openings sealed? ES NO Partial
LOCATIDN/'SEPARATIONS � ,�, 11174-1
Foundation to tank
Foundation to abscrpt6 ft .
Absorption to to _
of pits t-
LOCATION OF SYST PERTY One)
Front - Rear - eft si a fight side
cCMMENTSey
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Sy STEM USE APPROVE YES O
Buil i g T Spector
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