1992-121 C'ER,TIFI+ .TE CfF +CJIVIPLI Ai'rTE
TOWN OF QUEEN58URY
WARREN COUNTY. NEW YORK
Data 19
T'hi$ is to certify that work requested to be done as shown by Permit Now
has been completed.
Septic Alteration
This structure tray be occupied as a
Localearpitctimic ....
cm
owner Donald R r
Order 'Town Board
uJt 1V
y
T[]'wkV OF QU'EBNSBURY
Director of Bldg. do Code Enforcement
w
BUILDING PERMIT �
TOWN OF QUEENSSURY No 92- 121
WARREN COUNTY, NEW YORK N
f'V
1
PERMISSION is hereby granted to Don&ld A_, M r
OWNER of property located at 232 Pit her Road Street, Road or Ave.
Septic Alteration -v
in the Town of Clueensbury, To Construct or place a p
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. 's
O
1. OWNER'S Address is
'Scam �
d
A
2. CONTRACTOR or BUi LDEWS Name
RAN Transport
av
3_ CONTRACTOR or BUILDER'S Address r�7
PI
4. ARCHITECT'S 'Name
^t
Z7
C7.
5. ARCHITECT'S Address
B_ TYPE of Construction — (Please indicate by X1rb
rb
) Wood Frame 4 1 Masonry ( } Steel
A
T. PLANS and Specifications
Septic Alteration to include : r+
No 000 Gal Tank with 1 seepage pit 8' x 10 using #2 stone , 1 ` Thickness
as per plot plan specifications and application
B. Proposed Use
Septic Alteration
$ 25. 00 PERMIT FEE PAID — THIS PERMIT EXPIRES April 29 , 19 94
(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 thils,��' ay " f April 19 92
SIGNED BY
for the Town of Oueensbury
Bu ding and Zom Inspector
rOWN OF QUEENSBUH .
4Eao
TOWN OF QUEENSBURY "E0E!4/Er_)
APPLICATI -FOR SEPTIC DISPOSAL PnyE�RMRIT �� � Permi t # `� ✓�
Fee Paid
Date :
BLDG. & CODE Dni ewed By
Z- �c---�__ �
LOCATION OF PROPERTY FOR INSTALLATION : �1TC -
Owner ' s Name : -�7•
Owner ' s Mailing Address : 3 / f t'_ I�� vt �- 5
Installer ' s Name • ��� Phone # :
Number of bedrooms ( if residential ) : 4
Total daily flow ( residential - compute @ 150 gal , per bedroom ) : , '' al .
Topography-Circle One : Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One : Sand Loam Clay Other /Depth :
Ground Water-At What Depth ? Feet
Bedrock or Impervious Material -At What Depth? Feet
Percolation Test-Circle One : Not Required Required/Rate Min . Per Inch
Domestic Water Supply- Circle One : Municipal Well Other
If domestic water supply is a well - , Z -� feet
Separation : Water supply from a r
_ y septic absoption
PROPOSED SYSTEM- Septic Tanis gal . ( Minimum size : 1 , 000 gal . )
Tile Field : Each Trench feet//Total System Length feet
Seepage Pit ( s ) : Number -of / / Size each : ft . x ft .
Size of Stone to be used : # / Depth or Thickness feet
*ir/r dr irir,r k,tiitot Ar ir,Ar
HOLDING TANK SYSTEM IF REQUIRE
No . of Tanks Size of Each Gal .
Alarm system and associated electrical work to be inspected by^ a certified
agency. ,r„ kyEi, k K„k ky yrir k x,t
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 : p'�TE '
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 drywells
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 installation ,
alteration or repair of an approved system , a new proposal must be submitted
to the Queensbury Building Department before further construction .
Town of Queensbury
Building & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks :
C lown of Queenj i�t►'e�
BUILDING and ZONING DEPARTMENT
Bay R. D.
C�ee sburY. New York12801 9$
SEPTiic DISPOSAL SYSTEM INSPECTION
LOCATION r
DATE
// / '�f Z- PERMIT NO .
Sand �- clay - --
SOIL TYPE ired? YES O
Percolation Test Requ
Percolation rate - Min/Inch
TYPE of Sy STEM c
Absorption field. , total le th
Length of each trench
Depth of trenches
Size of gravel
SEEPAGE P ITS4D7ivmbe
Size-
f t. X
Gravel size S1z Type
PIPING ; Ye/LI r�
Bldg . to tank G-
Tank to dist . bans G
Dist. box to field/pit NO Partial
Openings sealed? s w- ES
LOGAT ION/SEPARATT-bl4 S i f t.
Foundation to tank ��
Foundation to absoltption
Absorption to lot. Fine
Separation of Pi PROPERTY circle one)
ION OF SYST�1 � � Right side -
Front Rear side
EN T, S
30 '
SYSTEM USE APPROVED YES NO
Building Spector
01/86 and vl
TOWN OF QUEEN5BUk ,
RECEIVED
APR G 1992 .
BLDG. & CODE GEPT.
Ito
qo or.
i i It
f .
i
� 4
j ! 4
(^
x C✓
qr
i
� f h
oeep
r
-'- � Vr
r
Loo..
M P
/ l -
Ftu -nEN'L'1D "Y
' ,Q