1989-913 BUILDING PERMIT
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TOWN 4F QUEENSBURY No. fig. 91�
WARREN COUNTY, NEW Y(3RK
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PERMISSION is hereby granted to JOSEPH SCARED
OWNER of property located at 3 Crestwood Drive Street, Road or Ave. `aw&
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.
t. OWNER'S Address is
SAME
2. CONTRACTOR or BUI LDER'S Name
Sanitary SewerOil
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction — (Please indicate by X)
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I ) Wood Frame I ? Masonry I } Steel ( 1
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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 and plot plan . m
S. Proposed Use
Sewage Alteration
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$ 25a00 PERMIT FEE PAID — THIS PERMIT EXPIRES Nnvpmb r 77 1S1 ] _—
(lf a longer period is required an application for an extension must be made to the Building and Zoning inspector of the fTl
town of Queensbury before the expiration date.) p,
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Dated at the Town of Queensbury this Day of Nnvember I91a9_ rn
SIGNED BY for the Town of Queensbury
Building and Zoning fnspector
TOWN OF t.,`3UEENSBURY
law APPLICATION FOR t
V > SEPTIC DISPOSAL PERMIT
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DATE ZL r /""
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LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name / C. Ce a 1A . f C +)x ,+tr-O Telephoner 3
Address:
Installer's Name: �"sv Telephone: 7 4 j. -
Number of bedrooms (residential only)
Total daily flow (compute (a 150 gal per bedroom)
Topography: Circle one 0an
Rolling Steep Slope % of Slope
Soil Nature: Circle oneLoam Clay Other. /Depth: Feet
Ground Water: At what depth? Feet
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle one: required required rate min. inch.
Domestic water supply: circle one: unici Well Other
If domestic water supply is a we
Separation: Water supply from septic absorption feet
DUB �ywsr
PROPOSED SYSTEM : Septic TankA gal. ( minimum size: 1 . 000 gal. )
TILE FIELD : Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of i��/ Size each��feet by feet
Size of stone to be used 0 /Depth or Thickness feet
I have read the regulation on the reverse s ' o s sheet and agr abide by these
and all requirements of the Town of Glue bu Sa itary Sew Di 1 Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
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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 . ) 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 ,
the fields and /or drywells
BV Nu system shall be covered before inspection and approval by the
Building Inspuctor . 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
he submitted to the Queensbury Building Department before further
Loiistruction .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
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BUILDING and ZONING DEPARTMEN
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Bay and Haviland Road, R.Dt 1 Box 98
()ueensbury, New York 12801
SEPTIC DI S OSAL SYSTEM INSPECTION p�
NAME
LOCAT I Cx! LL
/ f PERMIT NO .
h
DATE �
SOIL TYPE - Sand - Loam - Clay --
Percolation Test Required? YES - NO
Percolation rate - Min/Inch _
N
TYPE of SYSTEM-0 total length
Absorption field ,
Length of each trench
Depth of trenches
Size of ,;ravel..
SEEPAGEZJTS4N1ff"r )Size- ft. XGravel Sizes ' xe :' + Type
PIPING : --
Bldg . to tank
Tank. to gist. box - - -�-
to field/ t -
Dist_ bo : Partial
Openings sealed? ES;
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LOCATION/'SEPARAT ON f
Foundation to t nk
scption 't-
Foundation toy
Absorption to lot lime ft_
Sep; pi s PROPERTY {circle one)
z,OCATI S
Front 'e
eft side - Righ't side -
Cp�ENT
T E
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SYSTEM USE APPROVE YE
B i, Inspector
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