93-124 BUILDING PERMIT
TOWN OF QUEENSBURYciF
No. q3_j�,�
WARREN COUNTY, NEW YORK
-Z
PERMISSION is hereby granted to CPRt_E rzrI L t TTL�
OWNER of property located at Cy,FvFa-D -1-z Street,Road or Ave.
in the Town of Queensbury,To Construct or place a c A-LTERA-7-70//
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
sI-R R.o Lt_TE. fox 53 icv it pDq L.,E .71
C,LEVE-2b4iLE Ny
2. CONTRACTOR or BUILDER'S Name R)
i.P. @APR_ ' d
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
P
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( I Steel ( )
7. PLANS and Specifications
SEPT'Ic A1-TERA-7-10iv TV 1riCLLtze REPLACE.Y Fr' 7` v>c' Ei.(6fl 44
No. 5E m 4 Cc� T51160I A.K.DPu in P A IV i-i NC -- T I'I Ig5 PEW,
f}P PLI CATI(n/ , -Nrb P�-E7i PLA
8. Proposed Use
S E PD C STF/r)
$ 26,0o PERMIT FEE PAID—THIS PERMIT EXPIRES l4Pr;LL ,'Zio 19 9-
(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 1,1P1}l Da f P f'�t L, 19 q
SIGNED BY for the Town of Queensbury
Building and Z ing Inspector
TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
Fee Paid A(
Date: ;r-; t. ``r ,I icl3 Reviewed By r-pi
LOCATION OF PROPERTY FOR INSTALLATION: Cle,/e4,—cfctL
Owner's Name:
Owner' s Mailing Address:
Installer' s Name: 1 ,i� ,— Phone #: ""-) _O(ct--/
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom) :
Topography-Circle One: Flat Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loam Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: Not 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 gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s): Number of / Size each: ft. x ft.
Size of Stone to be used: # / Depth or Thickness feet
TS-25 1 \�- CLIA.4 Out I. — �<C ���C: I iv\
**************
x�`JI 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: DATE:
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:
2 Gov
TOWN OF QUEENSBURY
UILDING b CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name OdifiThrxJ -4
Location Ob.vvd2Jz..•
Date 111 Permit #
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
Dist. Box (to Field/Pi t
Openings Staled? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation toAbsorption feet
Separation or, Pits _ feet
Conforms as pr Plot Plan Yes No
LOCATION OF, SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
•
/64, area lie c.c,7e, 4 -4
SYSTEM USE APPROVED: YES NO
Arrived:
Departed:
Building Inspector
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DATE 47