88-810 CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date June 14 19 901r'
This is to certify that work requested to be done as shown by Permit No. 88-810
has been completed.
This structure may be occupied as a Single Family Dwelling _
Location County Line Road
Owner James Canavan
By Order Town Board
TOWN OF QUEENSBURY
Building N Zoning Inspector
BUILDING PERMIT �
TOWN OF QUEENSBURY
ro
No. 88-810 y
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to James Canavan
I
N
OWNER of property located at County Line Road Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Single FAmily Dwelling
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
3 Luzerne XXXX Plaza
Glens Falls, New York 12801 0
w
2. CONTRACTOR or BUILDER'S Name phi
d
w
SAME
3. CONTRACTOR or BUILDER'S Address N
rD
rn
4. ARCHITECT'S Name
5. ARCHITECT'S Address 0
0
rt
r
6. TYPE of Construction—(Please indicate by X)
fD
NXXWood Frame ( ) Masonry ( )Steel ( ) 0
W
a.
7. PLANS and Specifications
a
No. 2400 Sq.ft. Single family Dwelling as per plot plan, specifications,
and application, including septic and attached two car garage. �.
8. Proposed Use
Single Family Dwelling
N•
25.00 C/O
277.00
$ XXXM S nRN PERMIT FEE PAID —THIS PERMIT EXPIRES May 1 1989
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the W
town of Queensbury before the expiration date.) 5
N•
24th N
Dated at the Town of Queensbury this Da .of October 1988
.of ry
E
SIGNED BY C/ ' j for the Town of Queensbury F'
Building and Zoning Inspector p
TO BE COMPLETED BY BLDG. DEPT.
Application No. _.__
-30"In 0/ QueelliLry Permit Issued 19
BUILDING and ZONING DEPARTMENT Permit Expires 19
Bay and Haviland Road, R.D. 1 Box 98 zoning Designation /1
Queensbury, New York 12801 Variance No. /I/ OCT 19®�
Site Plan Review No. �� .
Approved by• BUILDING & CODE DEPT.
APPLICATION FOR
BUILDING AND ZONING PERMIT
# iF iE iE if iF if if ih # if iF #. # # # # # # # # # # iF # # iF # iE iF # iE 9E iF # # # # ;:•#
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. ANSWER ALL OF THE FOLLOWING.
The undersigned hereby applies for a Building Permit to do the following work which will
be done in accordance with the description, plans and specifications submitted, and such
special conditions as may be indicated on the Permit.
-----------------------------=----------------------------------------------------------------
The owner of this property is: James Canavan
P.O. Address 3 Luzerne Plaza, Glens Falls, NY 12801 Tel-793-3741
Property Location:County Line Road Tax Map No.. / Z/ -Z
Street number or building lot number
Subdivision name (if applicable) N/A
THE PERSON RESPONSIBLE FOR SUPERVISION_OF WORK AS REGARDS BUILDING CODES IS :
J. Canavan 3 Luzerne Plaza, Glens Falls, NY 12801 793-3741
Name P.O. Address Tel. No.
Name of builder Jc:--,Canavan Address 3 Luzerne P1. Glens Falls Tel. 793-3741
Name of plumber J. Canavan Address 3 Luzerne P1. Glens Falls Tel• 7qi-3741
Name of mason K. Baldwin Address W. Fort Ann Tel- 792-8860
NATURE OF PROPOSED WORK: * ZONING INFORMATION:
X Construction of a new building A PLOT PLAN MUST BE PREPARED AND SUBMITTED,
Addition to a building drawn reasonably to scale and attached hereto,
Alteration to a building showing clearly and distinctly all buildings,
(no change to exterior dimensions) * whether existing or proposed and indicate all -
Other work (describe) * set-back dimensions from property lines. Give
* street and number or lot number, and indicate
FOR DEMOLITION PERMIT, STATE SIZE AND * whether interior or corner lot. Show location
LOCATION OF STRUCTiJP.GS AFFECTED. * of water supply and location and configuration
* of, .septic disposal area.
* COMPLETE INFORMATION REQUIRED BEL0
* SEE ATTACHED MAP V
Size of property ' �- ft ft.
* Existing building(s) Size ft X ft.
* . . . . . . . . . .None
PROPOSED BUILDING AND USE: * Existing building(s) Use
2400 + sq. ft. * None
Size of new structure ft X
Foundation-pier/slab/crawl/partial full Proposed building, distance from property line
(circle one)
* Front yard 100 ft Rear yard qn ft
No. of stories (habitable space) 2
* Side yards "51 ft and 75 ft
Height (grade to ridge) 32' ft. * If on corner, setback from side street — ft
If residential, no. of families .1. . .
No. of rooms(excluding }baths) 7 * OCCUPANCY INFORMATION
No. of bedrooms 3
r * PRIMARY BUILDING
No. of bathrooms 2z One familydwelling
Prima-, heating s stein * . X g
Y g Y` Boiler * : Two family dwelling
Type of fuel oil
* ultiple dwelling / Number of units
No. of fireplaces to be inshmll.e& ' 1 MPermanent occupancy
Will a wood stove be installed? no *. .
* Transient occupancy
Central Air conditioning? no p
- *- uainess
BUILDING STYLE, PRIMARY STRUCTURE Industrial
* Other
Ranch Contemporary Log cabin * If addition, what will use be?
Raised ranch Mansion Duplex . . . . . . . . .
Split level Old style Bungalow
Cape Cod Cottage Other ACCESSORY BUILDING-
Colonial Row Town House * Detached garage/one car/ o car/ car
( CIRCLE ONE PLEASE ) * X Attached garage/one car/ two car _ car
Private storage building
ESTIMATED MARKET VALUE OF * +Other
CONSTRUCTION
$_1_5_0,000_OQ_= _2Q9�QQp.00
INFORMATION ON BUIIDI.NG SPECIFICATIONS, ON REVERSE SIDE OF THIS SHEET, TO BE COMPLETED!
Form BPA 4/86 and-vl
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS:
Type of construction, wood frame, fire safe,etc. Wood Frame
Will any second-hand or ungraded lumber be used? If so, for what? NO
Foundation wall material Modular Concrete Block Thickness 10"
Depth of foundation below grade (to bottom of footing) 814
Will there be a cellar? Yes Heated or unheated? heated Floor sq. footage 1344 sq ft
Will there be a basement? Yes Will any portion be used as living space? No
(If so, what portio sq.ft. - - Type of use?
Type of roof - slope)flat/shed/other Material. of roof Fiber glass shingle
Size, wood studs "X 6 " spacing 16 "o.c. length 8 ft. .
Joists(floor beams) lst. floor 2 "X 10 spacing 16 "o.c. span ft.
Joists (floor beams) 2nd. floor 2 "X 10 spacing 16 "o.c. span ft.
Overlays(ceiling beams) "X " spacing . "o.c. span ft.
Roof rafters "X It
sp.acingL o.c. span ft. •H
Roof trusses (pre-engineered) spacing "o.c. span ft.
Exterior wall finish Siding Of what material? Vinyl
Interior wall finish Sheetrock = paint & paper
If a garage is to be attached, describe materials to be used for FIRE SEPARATION:
5/8 Gypsonwallboard over 7/16 strand board
Is there to be an opening between garage and dwelling? Yes If so will a Fire-rated
door, enclosure, and self-closing device be-'provided? Yes
Will a flue-lined chimney be installed? Yes Height above roof 4 ft.
Depth of chimney foundation below grade ft. To footing of cellar.
Depth of fireplace hearth 2. ft. 6..in. '
Water supply - Municipal or private well Private well
SEPTIC SYSTEM _ Distance from ANY private well(including adjoining properties110' ft.
(A separate application is necessary for any repair or new installation of septic system)
Town of Queensbury A F F :1 D A V I T STATE OF NEW YORK
County of Warren
I swear that to the best of my knowledge and belief the statements contained
in this application, together with the plans an specifications submitted, are a true and
complete statement of all proposed work to be d eon the describ remises and that all
e.
provisions of the BUILDING CODE, THE'ZONING 0, NANCE, and all r laws pertaining to
the proposed work- shall be complied with, whet r ecified not, and that such work is ;{
authorized by the owner.
SWORN TO BEFORE ME THIS Signature - --- ------------------------- ------
er, owner's agent,arcnizect,contractor
1p� day of V t
19yy --
NANCY C. La'FLIJRE
NOTARY PUBLIC STF?'F OF NEW YORIK
RESIDINr !p•!Ln:,.
° y
Nocqry Pub c, Warren County, N.Y. My Commissicai
SPECIAL CONDITIONS OF THE PERMIT: {
- - ------
Byl
---------------------------------------
s TOWN OF QUEENSBURY.
WARREN COUNTY, NEW YORK
Application for: BUILDING PERMIT IN COMPLIANCE WITH THE NEW ,YORK
STATE ENERGY CONSERVATION CODE
A permit must be obtained before beginning work.:
ANSWER ALL of the following:
.1 . Gross floor area 2246+
2.. Type of heat Oil Boiler - Hot 'Water
3,. is the building mechanically cooled? NO
4 . Percentage of area of windows and doors 13.490
A. Over 16% Only
1. U value of gross area of walls, roof/ceiling and floors
o
exposed to ambient conditions
2 . Floor over heated spaces YES NO
a. Are foundation walls insulated? YES NO
1. If YES, what is the R value?
3 . Slab on grade YES NO
a. If YES , what is the R value 0f insulation around
perimeter of floor?
4 . Is basement heated? YES NO
a. R value of insulation
5. Type of insulation
B. Under 16% Only
Y. R value of roof and floors exposed to ambient conditions_
R-38
2 . R value of exterior walls R-19
3 . R value of glazed area R3.3
4 . R value of doors R14.8 .
5 . R value of floors over unheated spaces
6. R value of slab edge insulation - unheated slab_
7 . R value of slab insulation - heated slab
8. R value of' heated basement/cellar walls (above grade) R-11
9. R value of heated basement/cellar walls (below grade) R-11
10. Type of insulation Fiberglass & Styra Foam
C. Controls
1 . Thermostat maximum heat setting 90,
D. Duct Systems N/A - - - --- --- - -- - - '
1 . Is duct system installed in unheated spaces? YES. . NO
a. If YES , R value of duct installation
b. R value of duct in other areas
E. Piping Insulation
1. Size of hot water or ' cooling carrying agent pipe 3/41,
2 . R value of pipe insulation: 2.13 >.
F. , Service Water Heating
1 . Performance efficiency 80-85%.
2 . Temperature control setting ma mum 1600
G. For Swimming Pool Only
1 . Maximum heating NI AA ZO
Telephone No. 793-3741
A(ap�plicantls ' signature)
,5;�Svj QU&MA
APPLICATION FOR SEPTIC DISPOSAL PERMIT
DATE 10/1 188
LOCATION OF PROPERTY FOR INSTALLATION County Line Rd.
Owner's Name: Jim Canavan Telephone: 793-3741
Address: 3 Luzerne Plaza, Glens. Falls, NY 12801
Installer's Name: J. Canavan _ Telephone: 793-3741
Number of bedrooms (residential only) _ 3
Total daily flow (compute @ 150 gal per bedroom) 450
Topography: circle one: Flat Rolling Steep Slope %.of slope
Soil Nature: circle one: Sand Loam -Clay Other / Depth: feet
Ground Water: At what depth? feet Dry at 6'
1
Bedrock or Impervious Material: At what depth? 30+ feet
Percolation test: circle one: not required required / rate min. inch.
Domestic water supply: circle one: Municipal GDOther
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption _110' feet
PROPOSED SYSTEM: Septic Tank 1000 _gal. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
r/ Z
SEEPAGE PIT(S): Number of 3 / Size each 6' Di a. feet by U feet
Size of stone to be used # 2 / Depth or Thickness 2' feet.,around + under
IMP:.ORTANT
...Please...LIST NEW.EQUIPMENT TO BE INSTALLED
(over)
T
Section II 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 mater 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.
I have read the regulations above and a ee to abide by these and all requirements
of the Town of Queensbury Sanitary e a e Disposal e.
Signature of responsible person:
Date:
Town:of.Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTL '163 . . . HOME OF Nt. !.•RAl_ BEAUTY . . . F, UVE
JAMES M. CANAVAN
3 LUZERNE PLACE
GLENS FALLS,NEW YORK 12801
November. 3, 1988
Mr. Bert Martin
Town of Queensbury
Buidling Dept.
Bay &'Haviland Rd. .
Queensbury, NY 12804
Dear Bert:
Ref. Bldg. permit #88-810
Attached are two stamped copies of the revised foundation
plan for my house on County Line Road.
As I discussed with you, we will be changing from a block
foundation to a poured wall foundation and these drawings are
the revised foundation plans.
Please review them for acceptability and. return.one copy to
me
Thank you.
Yours truly,
T 'es M. Canavan
JMC:lg
Encl.
sw%-A�
f
W ,+ yt Ila
10,70,
. C
"?bCJOvo1 -S� � l
V
;CIO"
Nrl
�9G
� N •
i
�Wn
or S`c'
o -
co
0
M
L`
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 1280I
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT REQUEST FOR INSPECTION RECEIVED/`1,1
NAME
LOCATION 4
DATE j�- �Q PERMIT #
APPROVED
YES NO
FOOTING/PIERS
MOY,GEITHIC POUR FORMS
UNDATION/DAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULA N:
FOUNDATION
FLOORS
WALLS
CEILING \, '
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHE_'qSTE�S
STAIRS-CLEARANCE\& ILS
PLUMBING FIXTURES,R LIEF VALVE
INTERIOR TRIM/PRIVA� Y DOORS
FINISHED FLOORS
GARAGE FIREPROOFIN
DOOR CLOSER(S)
SMOKE DETECTORS
FINAL ELECTRICAL I SPECTION
FINAL APPROVAL OF ONSTRUCTION
A SIGNED CERTTPLTE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!'
REMARKS:
e
1
v �
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 12801 �----
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
G 7<�LOCATIO DATE PERMIT�� y (( PERMIT #
PPROVED
5 11rNO
� OOTING/PIERS
MONOLITHIC POUF FORMS
FOUNDATION/DAMPPROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH=IN
INSULATION:
FOUNDATION r'
FLOORS I
WALLS I
CEILING
FINAL INSPECTION: \ J
CHIMNEY HEIGHT /
ROOFING �.
SIDING
EXTERNAL PORCHES/STEPS
STAIRS-CLEARANCE RAILS
PLUMBING FIXTURES/RELIEF\VALVE
INTERIOR TRIM/PR, VACY DOOSS
FINISHED FLOORS \
GARAGE FIREPR FING \
DOOR CLOSERS) \
SMOKE DETECTO S \,
FINAL ELECTRIC L INSPECTION
FINAL APPROVA OF CONSTRUCTION
A SIGNED C TIFICATE OF OCCUPANCY MUST BE
OBTAINED F OM THE BUILDING DEPARTMENT BEFORE
THESE PRE ISES ARE OCCUPIED!
REMARKS: 1
� � S
d
INSPECTOR
re
to
X z
wo
vw
m El
x - M m
M> >
-4 C
CL
v 0 n ate >0 C7
D
Z r
> rmn o
m
a
IASI I
I t
ma
TOWN OF QUEENSBURY �
BUILDING AND CODES DEPARTMENT `�JL
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 1280&
TELEPHONE (518) 792-5832
BUILDING INSPECTOR`S REPORT ( � ��
REQUEST FOR
INSPECTION RECEIVED j, 1! jqo
NAMEf'
LOCATION �l a//� - k,{!i l ,
DATE PERMIT #
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FdRMS /
FOUNDATION/DAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING f
ELECTRICAL ROUGH-IN `+
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STEPS
STAIRS-CLEARANCE & ILS
iv
PLUMBING FIXTURES/ LIEF VALVE
INTERIOR TRIM/PRIVACY DOORS
FINISHED FLOORS f j 7
GARAGE FIREPROOFING 11
DOOR CLOSER(S) .-
SMOKE DETECTORSi
FINAL ELECTRICAL/INSPECTION f
_FINAL APPROVAL-0P CONSTRUCTION,: '
OK TO ISSUE C/Of,OR C/C
a
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROMr'THE BUILDING DEPARTMENT BEFORE
THESE PREMISLS ARE OCCUPIED!
'1
REMARKS:
ARRIVE
DEPART/
INSPECTOR
INFORMATION FOR BUILDING DEPARTMENT
WE ARE IN THE PROCESS OF ISSUING A CERTIFICATE
OF COMPLIANCE FOR THE ELECTRICAL INSTALLATION
AS COVERED IN AN APPLICATION FILED WITH OUR
DISTRICT, OFFICE.
THE /N'EW Yr�ORK BOARD OF FIRE UNDERWRITERS
APPLICATION NO. V,��J 0 3
LOC TION
DATE INSPECTOR
FORM IUD(REV.1/86)
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 12801
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION
DATE 16 ; PERMIT #
, APPROVED
r
YES NO
FOOTING/PIERS ;
MONOLITHIC POUR FORMS
FOUNDATION/DAMP—PROOFING
PACKFILL APPROVAL r
VROUGH PLUMBING 1 d
FRAMING )Y
ELECTRICAL ROUGH—IN'l
INSULATION:
FOUNDATION i 1
FLOORS
WALLS I
CEILING Pk
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING ( ''
SIDING
EXTERNAL PORCHY:91STEPS
-STAIRS—CLEARAN E & RAILS
PLUMBING FIXT RES/RELIEF VALVE
INTERIOR TRI /PRIVACY DOORS
FINISHED FLOORS R.
GARAGE FIRE ROOFING
DOOR CLOSE (S)
SMOKE DETE TORS
FINAL ELECT IC
INSPECTION ' '
FINAL,A L OF CONSTRUCTION
OK TO ISSUP C/O OR C/C
A SIGNED LCLERTIFICATE OF OCCUPANCY MUST BE
OBTAINED&OM THE BUILDING -DEPARTMENT BEFORE
THESE PR MISES ARE OCCUPIED,!-
Z
REMARKS:
, ARRIVE l
DEPARZ_�Z�.�f
INSPECTOR
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAVILAND ROADS
QUEENSBURY, NEW YORK 12804-
TELEPHONE (518)' 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME ZjjlUd �J✓11 �J�pp
LOCATION
DATE / PERMIT # ��c
APPROVED
YES NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING r
BACKFILL APPROVAL
J&H PLUMBING
ING c
ELECTRICAL ROUGH-IN r'
INSULATION: +'
FOUNDATION
FLOORS
WALLS +
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT 4
ROOFING
SIDING
EXTERNAL PORCHES/'STEPS
STAIRS-CLEARANCE & RAILS
PLUMBING FIXTUWES/RELIEF VALV;
INTERIOR TRIM/PRIVACY DOORS
FINISHED FLO S
GARAGE FIREPROOFING
DOOR CLOSES)
SMOKE DETE TORS
FINAL ELECT _CAL INSPECTION '
FINAL APPR VAL OF CONSTRUCTION "
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
0/
r
INSPECTOR
TOWN OF QUEENSYURY
BUILDING AND CODES DEPARTMENT
BAY & HA VILAND ROADS
QUEENSBURY, NEW YORK 12809- /
TELEPHONE (518) 792-5832
BUILDING INSPECTOR'S REPORT
REQUEST FOR INSPECTION RECEIVED
NAME
LOCATION 26E,-1-'YJ fZ
DATE - - G PERMIT ## �(�/�
APPROVED
YES NO -
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACKFILL APPROVAL
ROO--GH PLUMBING,
,
C�FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STEPS
STAIRS-CLEARANCE & RAILS
PLUMBING FIXTURES/RELIEF VALVE
INTERIOR TRIM/PRIVACY DOORS
FINISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSER(S)
SMOKE DETECTORS
FINAL ELECTRICAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION '
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!-
REMARKS:
INSPECTOR
Jown of Queenilury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME Z% 1 C/szl R
LOCATION
DATE / / PERMIT NO. V'0 ) o
SOIL TYPE - Sand Loam_- Clay -
Percolation Test Requi?ed? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption(field, total length
Length of each trench
Depth of trenches
Size of gravel, _
SEEPAGE P ITS{Nvinbe of) ff
Size- i ft. X \. ft. -
Gravel size ,
PIPING: <, Size Type
Bldg. to tank 4/ -
Tank to dist. box ' 4�
Dist. box to field/pi't V-L t-e'
Openings sealed? C Yi_S� NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ` % ft.
Foundation to absorption 3(D ft.
Absorption to lot line vZS- ft.
Separation of pits eft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
ront> Rear - Left side - Right side -
COMMENTS:
SYSTEM USE APPROVED lYE-_ NO
q.
Building Inspector
01/86 and vl