92-322 a
BUILDING PERMIT
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TOWN OF QUEENSBURY
No. 92-322 '
WARREN COUNTY, NEW YORK 1O
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PERMISSION is hereby granted to John Abbale
OWNER of property located at 11 Henrick Street Street, Road or Ave.
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in the Town of Queensbury,To Construct or place a Septic Alteration
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at the above location in accordance to application together with plot plans and other information hereto filed and p
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1. OWNER'S Address is
Same
2. CONTRACTOR or BUI LDER'S Name
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Jeff Lee rD
3. CONTRACTOR or BUILDER'S Address n
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4. ARCHITECT'S Name `+
5. ARCHITECT'S Address �
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6. TYPE of Construction—(Please indicate by X)
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( )Wood Frame ( ) Masonry ( )Steel ( ) p0j
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7. PLANS and Specifications 7
No. Septic Alteration to include: 2 seepage pits each 8' x 10'
using #2 stone, 2' thickness as per plot plan specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 9, 19 94
(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 9 Day o4 June 19 92
SIGNED BY for the Town of Queensbury
Building and Zoning In ctor
TOWN Or QUEENSPURY
APPLICATION FOR
v SEPTIC . DISPOSAL PERMIT
TOWN OF QUEEP��B�P
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$ 19y2
DATE BLDG. & CODE DEPT.
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: � ,�� Telephone:
Address:
Installer's Name: �G `'� ���— Telephone:
Number of bedrooms (residential only)
Total daily flow (compute (d 150 gal per bedroom)
Topography: Circle one Fla Rolling- Steep Slope % of Slope
Soil Nature: Circle on%j�a2.Loam Clay Other /Depth: Feet
Ground Water: At what depth? % Z Feet
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle o �: n �equired rate min. inch.
Domestic water supply: circle on c' _ ell Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
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PROPOSED SYSTEM: Septic Tank ��l/� gal. (;;i imuni size: 1,000 gal.)
TILE FIELD: Each Trench feet/Total system length. feet
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SEEPAGE-PIT(S): Number of �-. / Size each feet by feet
Size of stone to be used # Depth or Thickness �y4r.�caVy et
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 PER
DATE:
OVER
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.) lo_cation .and distance to any water supply
5.) size and dimensions of all tanks, distribution boxes,
the fields and/or drywells
B. - No system shall be covered be-fore 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: ,
EENSB
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TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date /(? Permi t # 1Z_ �
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: TotA Length _
Length of each trenc
Depth of trenches
Size of stone.
SEEPAGE PITS: Numbe. -
Size \-; ft. x ft.
Stone size PIPING: \ _ Size Type
Bldg. to T\a k
Tank to Dist. Box
Dist. Box to at
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank / feet
Foundation to Absorption _ feet
Separation of Pits feet
.Conforms as per Prot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YE NO
Arrived:
Departed:
Building Inspector
JoWn oIQ ueensl ur
BUILDING and ZONING DEPARTMENT
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Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME b rJab-�
LOCATION
DATE l / ��PERMIT N0.
SOIL TYPE - Sand�1 Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total leri
Length of each trench /
Depth of trenches f,
Size of grave =
SEEPAGE PITS{Number of)
Size- ft. X _ ' ft.
Gravel size
PIPING: Size Type
Bldg. to tankk15
Tank to dirt. box4 r
Dist. box to. field//pit; Zf- ���` j��1+
Openings sealed? YES, ', NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ; ft.
Foundation to absorption A7 ftt.^
Absorption to lot, line +,(0 ftf.—
Separation of pits ��ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - ear - Left side - fight side' -
COMMENTS:
tV its �.` , V&r o ry Pots txr,Z
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SYSTEM USE APPROVED N
Buildine Ins' ector
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