1989-863 BUILDING PERMIT
TOWN OF QUEENSBURY
No. F19-963
WARREN COUNTY, NEW YORK c
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PERMISSION is hereby granted to SC TT H PKINS
NO
OWNER of property located at 114 Newcomb Street Street, Road or Ave. I
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 Queensbury Building and Zoning Ordinance.
1 - OWNER'S Address is
SAME
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2. CONTRACTOR or BUI LDE R'S Name
Lei
Sanitary Sewer
0
3. CONTRACTOR or BUILDER'S Address �1
d. ARCHITECT'S Name
5- ARCHITECT'S Address
6. TYPE of Construction -- IPlease indicate by X)
I ) Wood Frame I ) Masonry i ) Steel I )
7. PLANS and Specifications
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No- Existing 1000 gal . tank with 1 6 ' x 11 ` seepage pit as per application and plot plan . -"
M
8- Proposed Use d�-y
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Sewage Alteration
to
m
rn
$ 25 , 00 PERMIT FEE PAID — THIS PERMIT EXPIRES November 2
(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 date.)
Dated at the Town of Queensbury 2nd Day of No Pmhpr 19R9_
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SIGNED BY for the Town of Queensbury rn
wilding and Za ing Inspector �
TOWN OF Q UEENS D UP Y ! �O 2 - 2 �
-�~- APPLICATION FC]Ra CY
SEPTIC DISPO:SAl;� PEiRIaI'I'r '. TO�YIy QF
Clel •4; Sall&t
eCp ocr �� 119
ATE 3 C3 P
LOCATION OF PROPERTY FOR INSTALLATION � � 2 f-- je (^-� coA406
Owner's Name: . ) C Q 717 No " ,r� _ `I`elephone: 7/ 9 3
Address; 1 1 z pi— Ll tiJ CO Ki 0Installer"s Name: SA ,A,) t L. Telephone:
Number of bedrooms (residential only) .�-
Total daily flow (compute (d 150 gal per bedroom ) L! [3
Topography: Circle one: la Rolling Steep Slope % of Slope
Soil Nature: Circle one.(S'ancfj 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 Municipal Well Other
If domestic water supply is a wel :
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank 1 00C), gal. ( minimum size: 1 , 000 gal.)
TILE FIELD: Each Trench - feet/Total system length feet
SEEPAGE PIT(S)e Number of _/ Size each feet by feet
Size of stone to be used # 3 /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 Queens 'Sanitary Sewage Disposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
DATE:
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
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 Iiispuctor . Failure to comply with this requirement may
result in the uncovering of the system by the installer and a fine
ui up to $ 250 . O0 .
Co An approved copy of Lila 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
he submitted to the Queensbury Building Department before further
construction .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
k�niarks
_Down p `c+Cuee +ns T
S3EPAF1T4JIEf,1T
BUILDING and ZOY 4' 3G I Box 98
Bay and "auiland NeY�oorkk 12801 �l/�
od
Oueensbury •
SYSTEM INSPECTION
SEPTIC DISPOSAL- SYS
LOCAL I ON C ' - 0 +✓
` PERMIT NO - �`
YSATB I rT _ CIaY -�
E - Sand - Loam YES NO
SOIL 1`-' "St, 'Required?
percolation _ Min/Inch
percolation rate
TYPE of SYSTEM total len t h
pbsorPtion
Tngth of each txe ch
Depth of trenches ---
of gravel ---- ��- -_ "
Size r
5 , TSaEi3�g
E'SP}'GE
Size- --�
Gravel
size 5 z
p=PIt3G - tank
Bldg - � cii5t . bo !6 4
T'anik to d/P axtial
Dist , I,d�= to fi
E5
Openings seale
TSONS t.
LOCp„TIOL3/'SEFp• tax3k
Foundati un t Lion
aticn a'lasc rP w
Found t lot line eft.
Ab rPtlon £ Pits TY t �e one)
Separation rr=4 � PROVE ide .
I,OCpTION e I of t side - Right. s
Front,
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SyST04 ..USE APPROVED
E5 NO
B'u
ing Inspector
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