1987-082 BUILDING PERMIT
TOWN OF QUEENSBURY No. 87-82
WARREN COUNTY. NEW YORK
PERMISSION is hereby granted to Mrs . Blossom Bittman M
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OWNER of property located at 28 Pershing Road Street, Road or Ave-
Sewage Alteration o
in the Town of Queensbury, To Construct or place a
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.
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1 . OWNER'S Address is 28 Pershing Road ' r
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Queensbury , NY 12801
2. CONTRACTOR or BUILDERS Name Prank Shaw
Morning Star Exe .
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3. CONTRACTOR or BUILDER'S Address
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d. ARCHITECT'S Name
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5. ARCHITECT'S Address
6_ TYPE of Construction — (Please indicate by X)
( ) Wood Frame l } Masonry ( ) steel ( }
7. PLANS and Specifications
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No new dist . box and 150 ft . leach field per application and plot:
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8. Proposed Use Y
Sewage system for dwelling ro
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$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES March 24th 8_�.
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of 4ueensburV before the expiration date_)
Dated at the Town of Queensbury this 24th Day of _, Mar h 19_87
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
TOWN OF QUE NS[34j c'f
APPLICATION FOR SEPTIC DISPOSAL PERMIT Fi
MAR 2 3 1987
J BUILDING £ik CODE DEFT.
MATE _ ee ice' 7> _ / `_!'>'? / ' F �l t✓ ! G! rJ
LOCATION OF PROPERTY FOR INSTALLATION �� s
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Owner's Name: Telephone: 9c � /
Address:
Installer's Name: Telephone: �yq TJ
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one: Flat Rollin Steep Slope of slope
Soil Nature: circle one: Sa Loam Clay Other / Depth: T 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 one: 09unicipa Well Other
IF domestic water supply is a WelIv
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM: Septic Tank /Jsl_ gal. (minimum size: 1,004 gal.)
TILE FIELD: Each Trench feet / Total system length _ feet
SEEPAGE PIT(S) : Number of OQ / Size each ,&) , . feet by feet
Size of stone to be used # , / Depth or Thickness feet
I M P O R T A N T
...Please...LIST NEW EQUIPM'EN r 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.
Co 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. Sbould 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• r
Date:
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD. PLACE TO LAVE
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BUILDING and ZfJTS4h3G S]Ef'ARTBoX 98
BaY and Hauiiand Roa York A280A
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SEP-TIC DISPOSAL-
SYSTEM INSPECTION
14 Air
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LOCATION
DATE clay _-_�_
- Sand I•['ait YES - 140
5C'iL TYPE fired?
P evcolation Test Reg Snch
percolation rate - Min/ � .
TYPE o f SYS EM 1d , total
r len5'�Y'�.�
Absoption b
Y,engtl' of each txanc - Y �-•��
Depth of trenches -�--
Size of gravel _
SEEPAGE P lT S4tsnmber �`_--
Siy�'- 5ix
'TY Pe
Size
PTF 114G
Bldg - to tanX
to dist . box �-- -'
Tank to f yeld/Px partial
Dist boX. 330
openings sealed?
V,CnTJot4 /sF .Rx.Txos = Z�
jon to tank '^�--ft.
Founder to absorption �.-�� t.
Foundation _"f
Absorption Of pits lot line one)
Separation oSYSTEMPRC7PE TY (circle
LgGpTI OF - Left Side - Right side -
Front - Rear
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Al u.)
SYSTEM USE APPRGVEp
YES No
Pu lding Inspect
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