1989-912 BUILDING PERMIT
TOWN OF +QUEENSBURY
No. s - 912
� � � WARREN COUNTY, NEW Y+CYRK �
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PERMISSION is hereby granted to _ _ FRANK KLIPPEL oa
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OWNER of property located at 23 W h i pno rwi 1 l Street, Road or Ave. 1
ry
in the Town of Queensbury, To Construct or place a Septic 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.
f . OWNER'S Address is
SAME
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2. CONTRACTOR or BUILDER 'S Name yes
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Sanitary Sewer '
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3. CONTRACTOR or BUILDER'S Address �.
7�.
4. ARCHITECT'S Name
S. ARCHITECT'S Address w
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B. TYPE of Construction — IPlease indicate by XI
f ) Wood Frame ! ) Masonry I ) steel f 1 r
r
7. PLANS and Specifications
No. Existing 1000 gal tank with two 6 ' x 8 ' seepage pits .
S. Proposed Use
Sewage Alteration . ,';
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$ 25 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES November 21 19 91 t326
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(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of flueensbury before the expiration date.)
Dated at the Town of Queensbury this 21st Day of November 19 89
SIGNED BY `.,� 'r ,r for the Town of Queensbury
Building and Zoning I nspector
TOWN OF QULr- ENSIBUIRZY
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APPLICATION FOR CQ[�rEE
SPI DISPOSAL PERMIT No R
E
$ co°e- o�pr
DATE
LOCATION OF PROPERTY FOR INSTALLATION
RO aK Ct,s fir •Au�i4. 1 �/
Owner's Name: // 1 � A+ "�C kIO X2 ;ac c'_ Telephone. 22
Address:
Installer's Name: .J .[1 , i t, I G �''�+�- Telephone: L - ^.:' "+`
Number of bedrooms (residential only)
Total daily flow (compute (d IS gat per bedroom)
Topography: Circle oneq Rolling Steep Slope % of Slope
Soil Nature: Circle one: dfanV Loam Clay Other /Depth: Feet
Ground Water: At what depth? Feet
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle one: not reired required rate min. inch.
Domestic water supply: circle one: unicipal Well Other
If domestic water supply is a we
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank 000 k�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 Sid is sheet and agree to abide by these
and all requirements of the Town of Glue sbu S nitary Sew 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
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 tankso distribution boxes ,
the fields and / or drywelis
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
LOl3S t ruc t Ion ,
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Naviland Roads.
Queensbury , New York 12804
kuniark5 :
lawn a/ Queen .3durY
BUILDING and ZONING DEPARTMENT
Bay and Naviland Road, R . Q. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INS_PECTION
NAME
LOCA-r I On+
DATE/e PERMIT
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? 'YES - NO
Percolation rate - Min/Inch -
TYPE of SYSTEM:
Absorption field , tota:V' length
Length of each trench '
Depth of trenches
Size of tgravel:_
SEEPAGE ; TS4NUMbe rpf) /
Size- 62fto X
Gravel size
PIPING : "Size Type
Bldgv to tank 1 �
Tank to list - x
Dist. boa_ to eld/
Openings seal d? YES 1`IC1 Partial
LOCATION/sE RATIONS
Foundation o tank �.ft
Foundation o abscrption ft .
Absorption to lot line ft.
Separation of pits t- >
LOCATION STEM ON PROPERTY (cixcle one )
Front - ar Left side - Right side
CCMMENT
SYSTEM USE AP.p.""'17 fY.s
Building Inspector '- '-
1 7 �
01/86 and V1 1W 6/ 6
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