89-528 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 89-528
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to John passmore
OWNER of property located at Cor Larki-y & Cleverdale Roads Street,Road or Ave.
in the Town of Queensbury,To Construct or place a Sewage 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.
1. OWNER'S Address is
Same
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2. CONTRACTOR or BUILDER'S Name
Joe Roulier, Inc.
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
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5. ARCHITECT'S Address r"
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( 1 Steel ( )
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7. PLANS and Specifications
No. Holding tank only as per plot plan, and application
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8. Proposed Use
Sewage Alteration
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$ 25 00 PERMIT FEE PAID—THIS PERMIT EXPIRES magetwom July 6 19 91 c°qo
(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.) 'y,
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Dated at the Town of Queensbury this th Day of 19 89_ O
SIGNED BY for the Town of Queensbury
B ing and Zoni I spector
TOWN OF QUEENSPURY
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APPLICATION FOR
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--yam > SEPTIC DISPOSAL PERMIT()Vt i%; :i a ,e,` ,, V
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DATE ' %/7 DATE _ ‘ , ,
LOCATION OF PROPERTY FOR INSTALLATION �,. /-:.)c �w.-,� ( ,
Owner's Name: ��, / .,, �����,,e Telep one: ---z/-4.
Address: ZK .( l_L`L v —/-, 47 ZZ -&c- // K. 72 72 o
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Installer's Name:/_- <- ,-)�,,, .., , _ � Telephone: �5 :>', K
Number of bedrooms (residential only) _
Total daily flow (compute ld 150 gal per bedroom) /S.0
Topography: Circle one•�plat / Rolling Steep Slope % of Slope /--tea /
Soil Nature: Circle one: Sand Loam Clay Other /Depth: Feet �2
Ground Water: At what depth? Feet --i,
Bedrock or Impervious Material: At what depth? Feet .‘,/
Percolation test: Circle one: not required required rate min. inch. ,�,/
Domestic water supply: circle one: Municipal Well Other ,1-/-1
If domestic water supply is a well:
Separation: Water supply from septic absorption feet / /�
PROPOSED SYSTEM: Septic Tank /.5 z gal. ( .) '`'�-`°`5c1�// `C�''
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TILE FIELD: Each Trench feet/Total system length 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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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 Seytgge ssposal Ordinance.
SIGNATURE OF S ONSIBLE PERSON:
DATE:
7 / y/
OVER
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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. Nu 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 installa-
tion, 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 and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
Remarks :
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Jown of Queensburty
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME --Pa„ eye-e_,
LOCATION G 1ereA
DATE 7' ' / PERMITNO.
/ 42 5'
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches
Size of gravel
SEEPAGE PITS4Number of)
Size- ft. X _ ft.
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box``
Dist. box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption ft.
Absorption to lot line ft.
Separation :of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS:I
):76A411/d IS? A..e 't—e
SYSTEM USE APPROVED E NO
Bui1 in nspector
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