1993-059 —I
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 93-059
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to MYRTI F HFRMANCE ifl
OWNER of property located at 13 HOLDEN AVFNUE Street,Road or Ave.
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. - m
1. OWNER'S Address is
same m
2. CONTRACTOR or BUILDER'S Name 'S
fD
Edward Ladd
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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ro_.
6. TYPE of Construction—(Please indicate by X) 31.
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. Septic alteration to replace tank only with 1000 gallon as per
plot plan, specifications and application.
8. Proposed Use
Septic system
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25.00 March 17 95 _n
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19 c+
cn
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the -5
town of Queensbury before the expiration date.) c+
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Dated at the Town of Queensbury this 17th Day f March 19 93
SIGNED BY for the Town of Queensbury
Building and n' Inspector
� � TOWN OF QUEENSBURY .dN OF QUEENSbi.,
APPLICATION FOR SEPTIC DISPOSAL PERMIT RECEIVElhermlt # q5 5q
Fee Paid xA5
MAR 1. 7 1993 .
Date: (2-/ '7- 91, 3 Reviewed By
^" rC• & CODE DEPT,
LOCATION OF PROPERTY FOR INSTALLATION: )3 7q"o/c€ ,y 1 0.Q_, j ( p,„e_e14 stx<,R)(
Owner's Name: )Y) y -1-) t /-(v r m ►9 uC6
Owner' s Mail ing Address: /3 flO /�,eii) i, use- . (Lc ,nSbt-Qie f ;INy/ -
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Installer' s Name: Ecd c,. )7,4 A (-{, h, A d (-4, Phone #: 1--)U 5"-76 J (p
Number of bedrooms (if residential ): ) -
Total daily flow (residential-compute @ 150 gal . per bedroom) : , 5 U 4 0
Topography-Circle One 411ft Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth:
Ground Water-At What Depth? IO Feet
Bedrock or Impervious Material-At What Depth? Feet
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Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Wel l Other /r(, )(1) ci)A-4 aQ
If domestic water supply is a well -
Separation: Water supply from a y s ept ic absorption feet
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PROPOSED SYSTEM: Septic Tank gal (Minim size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length M feet
Seepage Pit(s) : Number of / Size each: ft. x ft.
Size of Stone to be used: # / / Depth or Thickness feet
**************
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks Size\of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
agency.
****************
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 Queensbury Sanitary Sewage Disposal
Ordinance. /�
SIGNATURE OF RESPONSIBLE PERSON: jk),( 5 f' ICe ATE: LI /'7 U
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:
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