88-368 BUILDING N PERMIT
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TOWN OF QUEENSBURY No 88-368 ,
WARREN COUNTY, NEW YORK o
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PERMISSION is hereby granted to Wendy Litchfield O1
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OWNER of property located at 4 Pinewood Avenue 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. Q
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1. OWNER'S Address is L~
Same
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2. CONTRACTOR or BUI LDER'S Name
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Queensbury Sewer
3. CONTRACTOR or BUILDER'S Address
RD1 Upper Bay Rd.
Glens Falls, N.Y. 12801 b
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4. ARCHITECT'S Name p
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5. ARCHITECT'S Address G
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( ) Steel ( 1 to
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7. PLANS and Specifications
No. 1000 Gal. Tank and 2- 6' X 8' seepage Pits as per plot plan ti
and application
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8. Proposed Use n
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Sewage Alteration
$ 70.00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 1 1990
(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 10th Day of June 19 88
SIGNED BY19�G� for the Town of Queensbury
Building and Zoning Inspector
APPLICATION FOR SEPTIC DISPOSAL PERMIT �ONIPw'G&B1 CODES IDS'.
V 70M or 00FEISBURV
DATA
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LOCATION OF PROPERTY FOR INSTALLATION �(J
Owner's Name: �� �elephone:
Address:
Installer's.Name: prul' Ll/!": '��elephone: KZ
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one: lat Rolling Steep Slope % of slope
Soil Nature: .circle one: and Loam Clay Other / Depth: feet
Ground Water: At what depth? feet
Bedrock or Impervious Material: At what depth? feet
Percolation test: circle one: not required required / rate min. inch.
Domestic water supply: circle on Municipal Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption _ feet
PROPOSED SYSTEM: Septic Tanl��d�} _ gal. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench feet / Total system-length feet
SEEPAGE PIT(S): Number of _ 2 / Size each feet by feet
Size of stone to be used # _ / Depth or Thickness _ feet
IMPORTANT
_..Please—LIST NEW EQUIPMENT TO BE INSTALLED
(over)
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 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.
I have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Signature
%of responsible person: °
Date: ID
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832 -
Down of Queenj6ury '
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSA S STEM INSPECTION
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NAME
LOCATION A/W Gt� Drl
DATE !�. / PERMIT NO.
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each t ench
Depth of trenche
Size of gravel_
SEEPAGTS4Numb r of
Size- ft. X f .•
Gravel size
PIPING: iz T ape
Bldg. to tankI�
Tank to dist. box '
Dist. box to field s
Openings sealed? S NO artial
LOCATION/SEPARA IONS:
Foundation to ank ft.
Foundation to absorptio �_ft.
Absorption t lot line , ft.
Separation f pits ft.
O SYSTEM ON PROP RTY(circle one)
ront - ar - Left side - ight side -
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SYSTEM USE APPROVED/( YFF
Building Inspector
01/86 and vl
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