1989-889 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 89-889
WARREN COUNTY, NEW YORRK
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PERMISSION is hereby grantqd to ON & JANICE MAKI • -
OWNER of property located aE vW Lion t ra y Road Street, R cad or Ave. y e
as
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 7x-t
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
t. [OWNER'S Address is CA
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2. CONTRACTOR or BUILDERS Name
3_ CONTRACTOR or BUILDER 'S Address
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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B. TYPE of Construction — (Please indicate by X)
{ ) Wood Frame { ) masonry { ) Steel { ]
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7. PLANS and Specifications
No. xxxxxxxxxx Replace Greywater dry well 800 gal . C
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S. Proposed Use
Sewage Alteration a.
$ 25 . 00 PERMIT FEE PAIL] — THIS PERMIT EXPIRES November 9 1991
to
I I f a longer period is required an application for an extension must be made to t h a Building and Zoning inspector of the r�`I
town of Gueensbury before the expiration date_}
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Dated at the Town of Queensbury this 9th Day of November 19 89 z�
SIGNED BY for the Town of Queensbury rM
Building and Zoning 1 fillipecTor M=4
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TOWN OF QQUEENSBURY � r01VN
APPLICATICIN FOR
4. - SEPTIC DISPOSAL PERMIT aje
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4)41�ft '�'g$9
DATE ! Z 4_//
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LOCATION OF PROPERTY FOR INSTALLATION. 1 9
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Owner's Name: t �f �.- j Q 1 tcr4c Telephone:
Address:
Installer`s Name:_ on I r is IC4, -- c,.,0OTelephone: I , ) A7(0 V
Number of bedrooms (residential only)
Total daily flow (compute (d 150 gal per bedroom) L-+ TO
Topography: Circle one: Fla Rolling Steep Slope % of Slope
Soil Nature: Circle one: and Loam Clay Other /Depth: p "IL Feet
Ground Water: At what depth? Feet �, r
Bedrock or Impervious Material: At what depth? Feet
Percolation test. Circle one: 0 of require +required rate min. inch.
Domestic water supply: circle oneKI4unicip Well Other
If domestic water supply is a well:
Separation: Water supply from septic. absorption feet
c.t Cnre wr., �e Dry i' 42 e +� Soo
PROPOSED SYSTEM : 5�eTard �'�''a _ gal, ( minimum size: 1 . 000 gal.)
TILE FIELD : Each Trench AJIA feet/Total system length feet
SEEPAGE PIT(S): Number of / Size each feet by feet
Size of stone to be used #.LL/Depth or Thickness 4 —p 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 Queensbur anitary Sewage Dis osal Ordinance.
SIGNATURE OF OF REZPONSIBLE PERSERSON:
DATE:��
! 6 I 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 ,
tile fields and /or drywalls
B , No system shall be covered before inspection and approval by the
Building Inspector . 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
bu submitted to the Queensbury Building, Department before further
construction .
Town of Queensbury
BUILDINC and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
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