1989-928 BUILDING PERMIT
TOWN OF QUEENSBURY No 89- 928
WARREN COUNTY, NEW YORK • •
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PIE RMISSfON is hereby granted to 1
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OWNER of property located at I C3 Holden _ Street. Road or Ave.
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 C•
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372 Ridge Road =
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2. CONTRACTOR or BUi LDE WS Name '
Queensbury Sewer
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3, CONTRACTOR or BUILDERS Address �-
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4. ARCHITECT'S Name
S. ARCHITECT'S Address Q
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6. TYPE of Construction — (Please indicate by X)
{ ) Wood Frame ( ) Masonry C 1 Steel ( 1
[7, PLANS and SpecificationsNo- Existing 1000 gal tank with the fieldeach trench 54 ' for
a total s stem Ten th of 150 ' cnrn
Proposed Use
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Sewage Alteration M
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$ 25 00 PERMIT FEE PAID — THIS PERMIT EXPIRES November 27 19 91
(Of a longer period is required an application for an extension must be made to the Building and Zoning inspector of the C:�
town of Queensbury before the expiration data.)
Dated at the Town of Queensbury this th Day of November is $9
SIGNED BY for the Town of Queensbury
Building and Zon ng Inspector
TOWN OF QUE- ENSB UR.Y
APPLICATION FOR QU1ci=NS[���Y
RECE14F
SEPTIC DISPOSAL PERMIT
BLpG. & rC]fE DEPT-
DATE 00
LOCATION OF PROPERTY FOR INSTALLATION / Ici e
Owner's Name: / Cj r I_n r I / n f W Teleephone@
Address: ! U� [ 9 -
c ry
Installer's Name: r E p� (,r c c t r 7 � Telephone: J G
Number of bedrooms (residential only)
Total daily flow (compute (d 150 gal per bedroom) +5`t
Topography: Circle one: lot Rolling Steep Slope 96 of Slope
Soil Nature: Circle one: and Loam Clay Other /Depth: Feet
Ground Water: At what depth? q ! Feet
Bedrock or Impervious Material: At what depth? 'Feet
Percolation test: Circle one: not require required rate min. inch.
Domestic water supply: circle one: unicipa Well Other
If domestic water supply is a well:
Separation: 'Water supply from septic absorption feet
PROPOSED SYSTEM Septic Tank/ e-� gal. ( minimum size: 1 ,00t1 gal. )
TILE FIELD : Each Trench SZ feet/Total system length <� -�5 feet
SEEPAGE PIT(S)= Number of / Size each feet by feet
Size of stone to be used /Depth or Thickness / rr 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 Quee y Sanitary* Sew Dispos I Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: 77
DATE: -GtJ �f
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 .
Elie fields and / or dryweils
a , Nu system shall be covered before inspection and approval by the
iSuildin,g Inspector . Failure to comply with this requirement may
result in the uncovering, of the system by the installer and a fine
car 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
be submitted to the Queensbury Building; Department before further
cosistructlon .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Say and Haviland Roads
Queensbury , New York 12804
h atarks
flown Of Queenslur!f
(BUILDING and ZONING R b RTME T
Hay and Haviland Ftoad, 98
pueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
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NAME
LOCAT I Ohl
DATE 1� / PERMIT NOo
SOIL TYPE - Sand. - Loam - Claa/ �—
Percolation Test Required? YES - NO
Percolat,on rate - Min/Inch
TYPE of SYSTEM' -
Absorption £ field ,
total. 1 ngth
Length of each tench
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Depth of trenches "
size of grave] er of)
SEEPAGE PITS{N`►. ft
Size_ fto K`.0
Gravel size S , aS:LEalEE
PIPING : '7Bldg . to tankTank. to list_ box
Dist . box to field/ NO
,Openings sealed?
LOCATION/SEPARATI S = y ft.
Foundation to t tion ` 2 ft .
Foundation to ab orp ft .
tion to l line
Absorp iso
separation of P ON PROPE ( ircle one]
LOCATION OF SY e
Front - Rear - Left side -
3.
COMMENTS
SYSTEM USE APPROVE .
YES
Building Inspector~�
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