1987-156 BUILDING PERMIT
TOWN OF QUEENSBURY No_ 57-156
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to rD
ro
Streetr Road or Ave.
OWNER of property located at
12 June Drive
in the Town of Queensbury, To Construct or place a
Sewa a 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. m
1 . OWNER'S Address is 12 ,Tune Drive
Queensbury , New York
2_ CONTRACTOR or BUILDER'S Name Reliable Sewer Service
ry
3. CONTRACTOR or BUILDER 'S Address Luzern.e Road
Queensbury , New York 12801 m
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4. ARCHITECT'S Name
8_ ARCHITECT'S Address
6. TYFE of Construction — (please indicate by X)
l ) Wood Frame I ) Masonry ( I Steel ( ? rn
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7. PLANS and Specifications Per plot and
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1000 tanks dista box and 2 seepage Pits
No, aiPpl-ica ton - ry
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S. Proposed Use Sewage alteration for dwelling w
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10 . 00 April l5 Zg 89
$ PERMIT FEE PAID — TFIiS PERMIT EXPIRES
(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_)
A nil 19 87
Da
Dated at the Town of Queensbury this 15th Y of
1 . � �y r for the Town of Queensbury
SIGNED BY Building and zoning Insp//e``ct✓✓
1 , TOWN OF OUEFNSBURY 'W[ (N 0W- GrUEsikv`�,��is
BUILDING & ZONING DEPARTMENT L� �;J
SEF]AGF DISPOSAL PERMIT APPLICATION F APR 193
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1 . Owner ' s Name
+* BUILDING & CODE DEPT./+rE
Address
Telephone No � -=� !�
2 . Property location
3 . Name of person or firm responsible r installing system
' r Telephone No .
Addresst
4 . Number of bedrooms ( residential buildings only )
5 . Daily flow " ctallons/day
6 . Septic tank capacity gallons
7 . Topography flat rolling , steep
% of slope Z:z
8 . Nature of soil and depth:;
9 . If ground water , bedrock or impe vious material is apparent at what
depth does it "begin? ft .
10 . Percolation test : A is required
g is not required
C If requi-red what is the rate. minutes/inch
11 . Water supply : municipal welle other
12 . Type of system proposed . drywall the field , other
Any contractor, corporation , individual , etcv engaged in the construction
of a sanitary sewage disposal system who covers the same before inspection ,
does not have an approved permit , or varies from the approved application
will be subject to a penalty of $ 250 as provided for in section 6 . O10 of the
Queensbury Sanitary Sewage Ordinance .
Date ✓ �I C---� " Ign~ "zre~ a appi I a _
On separate sheet of paper submit a diagram of the proposed septic system
with all dimensions , including distance from any structure , distance from
property line and domestic water supply , etc . Include all dimensions of
the system itself .
Form 3 - 82
f
jieeen3etrc�
N11NG D�PARfbAF, �
ff pulLDiNG and ZO y Box 9S
Havi%a nd SO
Bay and Yo p 12801
+)ueensburY. New
SEPTIC DIS'POS/AL
SYSTEM I{.ySPEC'IICSAI
PE.P1'hIT NO
DATE Clay
13o
Sand L�+ ' ed' YES -
SOIL .gypE �---'
Percolation Test ReMxn/inch
Pexeolatl'�r' rate
APE Of SYST ' total length
A10,SO ty`�n fi.e].d .
th of eaoh trench
Leng �-"
Depth of trenches��r---
Size of gravel, x of)
SEEpp' GS PITS
f'
5ize� -7c-~- Type
ursvel size Size
PIP313G to
tangy _--- ----
Blfig • _------_"
Tani to dist. boatld/Pi- -___�_ �-
x to fiet o Par
--- atia
Dist . bo ealed'' YES
openings s
S�oCP iIO41/SEPARA`rlt S c f It"
Endatyon to tan
x - ---
t .
absorPt�on __-�--ft-
FounSation tc lot y i ne �``-ft.
Absorption to ---` circle one)
SeVaxata,orG o SY5TEK Ct4 PROPERTY 1c Side
IA�Txc70-3 OE Left side
vront _ Rear
CCVL149"Ts: /� L✓ /f j
SYS'f USE p.PE'Roy1E
13o
TnsPector
�jctee"Lurt
1f3G DEPARTMS�`lT
SUtUDI IG and Z0t4 1 sox 98
Bay and Havifand 1110VV Y4 k12601
QUeensburY.
Ila SYSTEM IPfSpE TI01d
SEpTIC 1DISP( /ril 1,
LpCATI
PERMIT Pdb . f
DATE Lam"" _ Loam - CI Yy
'TYPE S -ecluired?
Tes ES
sexx.. t �.__..'
Percolation _ Min/Inch
Percolation rate
TYPU of SYSTEM= feta
-h l lenc3th
Absorption f 1 j
Length of each trench
Depth of tren cy,es ----
Size of grasTel� per of!)
SVBpNGE P ITS�13u�n]n f t.
x _---
slze- Type
Gravel Sx ze size
pIp114G to tank
Bldg • box ----_.
Tanis t 'to. f field/Pit martial
Dist. bolYES IIO
Openings sealed .
SEPAP-PaIC�P35
LpCATId / to tank -___..ft .
T,,,annndation tion -- ft-
datian to absarp
Eosin to lot line ----ft-
AbSorPt' an its 01,
OPER`� (circle
separation of P ht side
y CA�T.'I dE SACS't e fide _ Rig
Frontj _ -gear �__
C,�EI3TS
E APpRgVED
YES NO)
SY STD f
/y�y� A h /� / L y
e Lot
Bui ain4 ynsp
p1/s6 and vl
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