1994-625 BUILDING PERMIT
TOWN OF QUEENSBURY
No.
6/4)
WARREN COUNTY, NEW YORK
f ,
PERMISSION is hereby granted to Cd3 �.-t1/ij4 2
OWNER of property located at c watt. etI_ / Pt;t Street, Road or Ave.
d
in the Town of Queensbury,To Construct or place a ,___14,10 ue,
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
&tip Vel VAL &pop__
2. CONTRACTOR or BUILDER'S Name
Val DIA It.A.Lidi ita>
3. CONTRACTOR or BUILDER'S Address
(0 J
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No.
C
8. Proposed Use
$ c,,Q5. a") PERMIT FEE PAID—THIS PERMIT EXPIRES 0 O 62519 /5
(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 }(.., 19 qi-j
SIGNED BY for the Town of Queensbury
Building and Zoning ctor
t5co/ e
a.
/ TOWN OF QUEENSBURY
ibaki
;AWN'N APPLICATION FOR SEPTIC DISPOSAL PERMIT
DATE
2/ 'A9/64
LOCATION OF PROPERTY FOR INSTALLATION � kWi( 4h10 - A /6'7/ p24-
Owner's Name: 4r
Address: ple. I I Z4 1,,A g C E /4Y /ZB ,
Installer's Name: V'4- 3 ) , it ),0„tc. Telephone: "7 60 - S �
Number of bedrooms (residential only)
I0
Total daily flow (compute @,166Thal per bedroom) :BCC) a
Topography: Circle onelle0 Rolling Steep Slope % of Slope
Soil Nature: Circle one: SandClay Other ��1 /DeP Loam .--__ th: /
11
Ground Water: At what depth?: /- 'Feet igarriik.4 CP 2,6
Bedrock or Impervious Material : At what depth? Feet
Percolation test: Circle one: not required required
Rate - 5 Min. Per Inch
Domestic water supply: Circle one: Municipal Well Other l. rk . /iu7 '/t'JELL
i P
If domestic water supply is a. well :
Separation: Water supply from any septic absorption ? ) feet.
PROPOSED SYSTEM: Septic Tank DQ() gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench /4- feet/Total system length feet
SEEPAGE PIT(S): Number of / /1- /Size each feet
by feet
Size of stone to- be used # 11- I /i,/Depth or Thickness feet
*****************************
HOLDING TANK SYSTEM IF REQUIRED M.
NO. of Tanks P r Size of Each ti //- Gal .
J'- - *Alarm system and associated electrical work to be inspected by an _approved
a ency.
'- vread the regulation on the reverse side of this sheet.and agree, to abide
' $e and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Odance.
SIGNATURE OF RESPONSIBLE PERSON: DATE: A94/014
. l
Ivtic 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 shoving:
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,
cile,_.,fields and/.or drywalls
B. Nu system shall be covered before inspection and approval by the
tuilding 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 produc.s. said plot plan at time of inspection say
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
construction.
Torn o"f Queenabay
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
•
Remarks:
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name le,E *
Location — 1,At4._ Ppkeyb3W-1
Date 1,0191 Permit # CI --(Dab—
SOIL TYPE: Sand-Loam-Clay-
Resul is of Percolation Test-
(if applicabl ) Rate-Minute/In
TYPE OF SYST •
ABSORPTION FI : Total Len:th
Length of e h trench
Depth of trenches
Size of stone
SEEPAGE PITS: Numb=r
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Bo
Dist. Box to Field/Pit
Openings Seal e.? Yes No Partial
LOCATION/SEPA! 'TIONS:
Foundation t• Tank feet
Foundation • Absorption feet
Separation if Pits _ feet
Conforms a. per Plot Plan Yes No
LOCATION r SYSTEM ON PROPERTY:
(circle • e)
Front - 'ear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
616Te_tA ‘Wct24 )E_D DO
3122q-ts- M ocv.- : iTik
A por\-- bv- tE__Ii V\6a,
0- 9 4-7-)5z_ cuo3t__ DOI
SYSTEM USE APPROVED: YE 0
Arrived:
Depa -I : JP
iiiirr
i:uil ping I ('p: tor
, 2 is-ft--
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
L 518-745-4447
xiL--�
` Ft DISPOSAL SYSTEM INSPECTION
l Name ti
Location r
Date P ' it # 90/-6A5
SOIL TY E: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Ra e-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: otal Length /
Length of each tre ch / a
Depth of trenches
Size of stone
SEEPAGE PITS: Num•er-
Size - ft. x ft.
Stone size
PIPItG: Size Ty
p()
Bldg. to Tank
Tank to Dist. Box 1110
Dist. Box to Fi - d Pit
Openings Seale . Yes No Part'al �`
LOCATION/SEPA' �TII S:
Foundation • Tank feet /,',':,Foundation o Abso •ti on feet ,c
Separatio of Pits feet
Conforms as per Pict t Plan Yes No
LOCATI' OF SYSTE ON PROPERTY:
(circi - one)
Front - Rear - Le't Side - Right Side
Midd e Front - Mi'dl a Rear
CI 3 TS:
4 ri i L ('i 1v t-o,z 4 S i h ?LA,vS
" - ri e PLA,vS- OK-MOD Ait._If-fain
C L r Ws A' 3-+okl OF-I ,v c-% A MO
soC- PtPi
SYSTEM USE APPROVED: YES NO
Arrived:
Departed:
Building nspec o