91-203 � � T
BUILDING PERMIT
TOWN OF +QUEENSBURY No 91-203 �
WARREN COUNTY, NEW YORK �
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PERMISSION is hereby granted to Louis Rathbun
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OWNER of property located at BD#4 BOX 229 Ohio Ave . 'Street, Road or Ave.
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in the Town of Clueensbury, To Construct or place a Septic. 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 ap
Sam !A�
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2. CONTRACTOR or BUI LDERS Name
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Ronald gillly �.
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a CONTRACTOR or BUtLDER 'S Address �p
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4. ARCHITECT'S Name O
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S. ARCHITECT'S Address
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6. TYPE of Construction — {Please indicate by X)
I ) Wood Frame ( 1 Masonry ( 1 Steel ( 1
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7. PLANS and Specifications
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No. Septic Alteration to include: 1000 gal septic tk with 1 seepage pit
8 ' x1U ' with #3 stone as per plot plan specifications and application
S. Proposed use
Septic Alteration
$ 25. 00 PERMIT FEE PAID — THIS PERMIT EXPIRES April 17 , t9 93
(If a Conger 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 17th Day of Apra 1991
SIGNED BY for the Town of Queensbury
Building and Zoning I nspdKor
TOWN OF QUEENSBIJRY C
APPLICATIOrl FOR SEPTIC DISPOSAL PERMIT l !
TOWN OF CIUEENSBUR'Y
RECEIVED
DATE : ��� �/
LOCATION OF PROPERTY FOR INSTALLATION .2 2 AP 16 190
Owner ' s Name : pG/1S ,r ', , ,�, �.y BLDG. & CODE DEFT.
Address :,4PY -
InstaTTer ' s Name : 't ,r�f %� Telephone 7yel9�
Number of bedrooms ( residential only ) f
Total daily flow ( compute @ 150 gal per bedroom )
Topography : Circle one : Flat Rolling Steep Slope 9K 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 req ru edjrequired
Rate - Min . Per Inch
Domestic water supply : Circle one : Municipal Well Other Wn 1Z e )
If domestic water supply is a well :
Separation : Water supply from any septic absorption XII, 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 $ feet
by ..Zo �feet
Size of stone to be used /Depth or Thickness feet
�Ir�lririk*iryt*titir*sr4erlrye,tr,tr,�r#Me tlr*�rahrralryrvMr
HOLDING TANK SYSTEM IF REQUIRED
NO . of Tanks oz Size of Each /_,04 .. Gal
*Alarlm system and associated electrical work to be inspected by as approved
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 : % ,//�rize2 - - DATE : ` t
Septic sure■ Inspections :
A . All appiication9 for septic eyscem installationr alteration or repair ,
as required by the Town of Queensbury Sanitary Sewage Ordinance , shall
be submictdd to the Building Departmenc at leasc 24 hour* before * cart
of construction and shall include a plot plan showing :
1 . ) the proposed location of Cho *yet*&
2 . ) Location and distance to lot limes
3 . ) Location and distance to structures
4 . ) location and distance to any water supply
5 . ) size and dimensions of all canks , distribution boxes ,
tiles fields ant / or drywells
S . No system shall be covered before inspection and approval by Cho
tsuildinS Inspuccor . Failure to comply with this requiremenc may
rudult in the uncovering of the syscsm by the installer and a fine
of up to ; 250 . 00 .
C . An approved copy of the ploc plan shall be available on the construction
aiCe . Failure cc produce said ploc plan ac tiss of inspecclon : y _
result in an Immediate work stoppage ,
D . Should unforeseen problems during construction prevent proper installa—
tion , alteration or rupalr of an approved system, a new proposal s#usc
tau submitted to the Qu"unsbury Building, Deparcmenc before further
coex* truccion .
Town of Quesnsbury
BU I LDT NG and CODES DEPARTMENT
Say and Haviland RoaAM
Quednsbury , Now York 12804
k,:nuarks : ,
TOWN OF QUEENSBURY
BUILDING 8 CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ' A`rua )k)
Location C) L1 faN61 E43 0
Date S,"=9 000-99 Permit
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SOIL TYPE; Sand- Loam- Clay-
Results of Percolation T
( if applicable ) Rate- M ' ute/I h
TYPE OF SYSTEM!:
ABSORPTION FIELD : T al Leng
Length of each tre ch
Depth of trenches
Size of tone
SEEPAGE er-
Size - t
x ft .
Stone size
PIPING: Size ype
Bldg . to Tank
Tank to Dist . Box
Dist . Box to Field/Pit
Openings Sealed? Yes'No a'rtT57
LOCATION/SEPARATIONKS :
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY :
( circle one )
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS
P iT-
SYSTEM USE APPROVED : Y NO
Arrived:
Departed :
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