1993-136 —'.
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••• ' 'z:CE g a I.: 1141ICATE - 111F CillMt LIANCE
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• TOWN OF QUEENSBURY, .
• WkRREN. COUNTY; NEW PORK
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. • Date ' 4';i7.646> ,tA . 19,92
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This is to certify that work requested to be done as shown by Permit No.
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This structure may be used as a
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Location 9
, Owner Ai/// ,,- -,/ il. /71,0//
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. By Order of Town Board .
i . TOWN OF QUEENSBURY
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. • Director:'.of Building & Code Enforcement
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BUILDING PERMIT 3
TOWN OF QUEENSBURY No. Q34 3o
WARREN COUNTY, NEW YORK _
PERMISSION is hereby granted to MI LLI R1 14 , I4/-I LL
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OWNER of property located at q LUPINE L AI(E Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Si PTC AL'1 TIC
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 F
JQ-r o€
2. CONTRACTOR or BUILDER'S Name
Co rnel pns 6ep-1-i n .apf ct.1 n
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction— (Please indicate by X)
( )Wood Frame ( ) Masonry ( I Steel ( )
7. PLANS and Specifications
Se_p-I-I`c aid a--) -4-2) )ncl Led e- 20,0 -Ce- 6.)4 -I-I‘Ie (d
No- 03- 50 -c+• 1en91-1-6 as per prof pt&v and appll ca -ior)
8. Proposed Use
.Sep-F-i c Sys 1-e-'
$ �00 PERMIT FEE PAID—THIS PERMIT EXPIRES ((PRIL l& 19 q3 (13
(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 this Day of APR IL 19 93
SIGNED BY for the Town of Queensbury
Building and Zoning In ctor
O
y TOWN OF QUEENSBURY 1
1 1gx,4 APPLICATION FOR SEPTIC DISPOSAL PERMIT
DATE:
LOCATION OF PROPERTY FOR INSTALLATION Z U p/V E 1993
Owner's Name: pi iiAA.1`�. H W41I-t f'° g- a cf)TIF n pr
Address: Z .� 'f v £ 1-a.r1i
Installer' s Name:ryv j�eey f, crD--ic'c ')6 li Telephone: 2PO O.TY2_.,
Number of bedrooms (residential only) 3
Total daily flow (compute @ 150 gal per bedroom) 165<1
Topography: Circle one: go Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand Loam Clay Other /Depth:
• Ground Water: At what depth? Y1/j4 Feet
Bedrock or Impervious. Material : At what depth? 40 Feet
Percolation test: Circle one: Cot required required
Rate - Min. Per Inch
Domestic Water supply: Circle one: Municipal Well Other
If domestic water supply is a well :
Separation: Water, supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank 1JQO gil .
164 (minimum size: 1,000 gal )
TILE FIELD: Each Trench _32, feet/Total system length 2— ' d feet
SEEPAGE PIT(S): Number of /Size each feet
by - feet
Size of stone to be used /Depth or Thickness / feet
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HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal .
*Alarm system and associated electrical work to be inspected by an approved
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: DATE: ' ^��
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Septic 3 stem Inspections: •
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A. All applications for septic system installation. alteration or repair,
as required by the Town of Quesnsbury Sanitary Sewage Ordinance, shall
be submitted co the Building Department at leasc 24 hours before start
or construction and shall include a plot plan showing:
1.) the proposed location of the system
. 2.) location and distante co lac lines
3.) location and discanci co structures
4.) location and distance co any water supply
5.) size and dimensions of all tanks, distribution boxes.
cile fields anal/or drywalls
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B. No system shall• be covered before inspection and approval by the
auilding Inspuctor. Failure to comply with this requirement may
result in the uncovering of the system by the installer and a fine
of up co $250.00.
C. An approved copy of the plot plan shall be available on the construction
lice. Failure co produce said plot plan at cise of inspection may
rusulc in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper iflaealla-
cion, alteration or repair of an approved system, a new proposal must -
bu submitted co the Quesnsbury Building Department before further
construction.
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Town of Quesnsbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Quesnsbury, New York 12804
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TOE OF QUEEN'SBURY
BUILDING S CODE ENFORCEMENT
Y 531 Bay Road
Queensbury NY 12804
2 518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
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Name Lf2 ULUIJ 9Z/C/v
Location 9 JLC//41(46p '
Date 4,ZU/q3 Permit # 93- /,fib
SOIL TYPE: sand- oam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length 24P-0
Length of each trench S.o
Depth of trenches , ` ,
Size of stone # � ,
SEEPAGE PITS: Number- p
Size - ft, x / ft.
Stone size /
PIPING: / Size Type
Bldg. to Tank y sG�
Tank to Dist. 0ox / ' Y ,(
Dist. Box to Field/ 4 5"4r✓
Openings Sealed? Artrio No Partial
LOCATIOfd/SEPARATIONS:
Foundation to Tangy 3o feet
Foundation to Ab "o`rpti on _li S feet
Separation of Pi,ts \ -- feet
Conforms as per Plot Klan 'es) No
LOCATION OF SY EM ON PROPERTY:
(circle one)
Front - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS: Rc-e
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SYSTEM USE APPROVED: tipNO
Arrived:
Departed:. ,:,i /0 .
Burin Inspector
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