93-415 BUILDING PERMIT
TOWN OF QUEENSBURY ro
No. 93-415 0
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to HENRY SAHLKE
OWNER of property located at Ridge Road Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Septic System
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
Star Rt Box 165 r
Queensbury NY 12804
2. CONTRACTOR or BUILDER'S Name
Peter Sahlke
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3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
H-
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5. ARCHITECT'S Address (D
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6. TYPE of Construction—(Please indicate by X)
( 1 Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications Septic system to include:
1000 gallon septic tank with one 27 ' x41 ' Wisconsin
No. Mound as per Engineer' s drawings and plot plan.
8. Proposed Use
Septic System
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25 . 00 PERMIT FEE PAID—THIS PERMIT EXPIRES JULY 29 19 95 0
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the U)
town of Queensbury before the expiration date.)
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Dated at the Town of Queensbury this 29 Day July 19 93
SIGNED BY cji for the Town of Queensbury
Building and Zoning In ctor
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s R .1.232424
j TOWN OF QUEENSBU ?>
APPLICATION FOR SEPTIC DISPOSAL '; 'MIT 10 mit #
A? * Paid
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Date: 7 ._ 2 6- 71 ''evie -d By Ilk_
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LOCATION OF PROPERTY FOR IN ALLATION: /Z
Owner's Name: tiZa
Owner' s Mailing Address: `` /76ys ,.3G(.,
Installer' s Name: /c 4 Phone #: ‘ 5 - ? ) F 7
Number of bedrooms (if residential ) :
Total daily flow (residential-compute @ 150 gal . per bedroom): ? QO
Topography-Circle One: 671-a, -.) Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth: 347
Ground Water-At What Depth? A„...1Z Feet
Bedrock or Impervious Material-At What Depth? 70 Feet
Percolation Test-Circle One: Not Required Required/Rate /7 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 ;Zoo feet
PROPOSED SYSTEM: Septic Tank / aOOO gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s) : Number of d / Size each: -c ? ft. x
Size of Stone to be used: # 02 / Depth or Thickness /0 f1,-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: /2 [/� U DATE: 2 - -2 3
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:
.()_S_ ( -7 / a v 0}/f
TOWN OF.QUE 4 SBURY
BUILDI3G & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
9518-745-4447
EPTIC DISPOSAL SYSTEM INSPECTION
a.�
Name az. , 51‘,-;/21,e____ tjekm-A-
Location led 41, 4)44%
1 , c� e2net`4,c_ A
7
Date Permit i t # fg_41/.5-
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box\ '`t
Dist. Box to Field/P;.lit
Openings Sealed? es No Partial
LOCATION/SEPARATION :
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits , �3 _ feet
Conforms as per PlotP!l an Yes No
LOCATION OF SYSTEM OROPERTY:
(circle one)
Front - Rear - Left ,Side - Right Side
Middle Front - Middle Rear
COMMENTS: ':
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3 o2 L /c-el >,/,L ; ..�o74 &4.
Ok rTl Ceuer f7ie1�.�
/rer :4`I e /(l' i- 4/0
c;a,,I.er
cdr3 ITS/! ) 00- 0011,4
SYSTEM USE APPCfOyED:Q YES 4.il�t
Arrived: /_31-
Departed: 5t::
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Buildi . Inspector