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1989-911 BUILDING PERMIT TOWN OF QUEENSBURY No. ���� � x WARREN COUNTY, NEW YORK -a 3 . a -- PER MISSI0N is hereby granted to ROGER CUTTER . . OWNER of property located at 37 Boulevard Street, Road or Ave. ro 1 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 2. CONTRACTOR or BUI LDER'S Name l7 G Sanitary Sewer M z 3, CONTRACTOR or BUILDER'S Address �p !f7 X$2XX87LNA]{ 792-7257 rTl �o 4_ ARCHITECT'S Name 5. ARCHITECT'S Address V B. TYPE of Construction — (Please indicate by X) rm. ) Wood Frame ; 1 Maaonry ; I Steel ; 1 7. PLANS and Specifications No, Existing 1000 gal tank with two 6 ' x 8 ' seepage pits as per application and Rlot plan . 8_ Proposed Use Sewage Alteration a� $ 25 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES November 221, 199119 . . � (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Qusensbury before the expiration date,) �rn�pp Dated at the Town of Queensbury this 22nd Day of November 19 89 J"`.. SIGNED BY for the Town of Queensbury Building and 2oni Wrispector MWN OF QUEENSBURY UcTS � 7 nF Qu€jatasBulkY APPLICATION FOR ptEO£d+vso SEPTIC DISPOSAL PERMIT : BLT�G. & cooe DEFT- DATE LOCATION OF PROPERTY FOR INSTALLATION Owner's Name: CA�+�2 `. +! i°!t Telephones_ ', ' Address: Installer's Name: /^ r' Telephone: Number of bedrooms (residential only) Total daily flow (compute ( 150 gal per bedroom) YZE-0 Topography: Circle on Flai Rolling Steep Slope % of Slope Soil Nature: Circle one* d'§andP Loam Clay Other IDepth: Feet Ground Water: At what depth ? Feet Bedrock or Impervious Material: At what depth? Feet Percolation test: Circle one: not require required rate min. inch. Domestic water supply: circle one: Iunicipaa`, Well Other If domestic water supply is a well: feet Separation: Water supply from septic absorption PROPOSED SYSTEM : Septic Tank 000 gal. ( minimum size: 1 . 000 gal. ) TILE FIELD: Each Trench - feet/Total system length feet SEEPAGE PIT(S): Number of / Size each_ ,a feet by feet size of stone to be used # /Depth or Thickness - feet I have read the regulation on the reverse sid his sheet and agree to abide by these and all requirements of the Town of Glue sb ry S itary sewage D ' sal Ordinance. SIGNATURE OF RESPONSIB&E PERSON: DATE: 2 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 lnspactor . 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 . 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 Queansbury Building Department before further cotia t rucC ion . Town of Queensbury BUILDING and CODES DEPARTMENT Say and Haviland Roads Queensbury , New York 12804 l:tmark� BUILDING and ZONING DEPARTMENT Bay and HaViland Road, R. D. 1 Box 98 QueensburY, N York 12801 /r 3v SEPTIC DISPpSA SYSTEM INSPECTION NAME LOCATIQAj DATE J/ pE.12MI �- „rry^:►����� �, _ SOIL TYPE - Sand - Loa Percolation Test Re Clay rate Percolation Min q c1? YES - NO - n nch TYPE of SYSTEM: L Absorption field , total ength Length of each trench Depth of trenches Size of Travel SEEPAGE ;'I'TS.(N' er of) Size- 5'''ft. X Gravel size ft. PIPING : i2 8 Type to tank Tank to dist . box Dist. boy: to fief oPenings sealed? YE N Partial LOCATION/"SEFA TIONS Faundaticin to tank Foundation t l ft. Absorption © lot line t. SeParatio lot Line -�_ t. LOCATION of STFpit f - SYSTEM ON PROPERTY ( ' rcle one) CrCY�iMEN S ear Left side - Right side SYSTEM 1ISE APPROVE YES ~ / it %ng Inspector 01/86 rnd v1 houll