1987-132 BUILDING PERMIT
TOWN OF +QUEENSBURY No. 87-132
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Raymond Wiles 0
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OWNER of property located at 32 Pershing Road Street, Road or Ave. A.
in the Town of Queensbury, To Construct or place a Sewage Alteration
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at the above location in accordance to application together with plot plans and other information hereto filed and m
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance-
[ , OWNER'S Address is 32 Pershing Road
Queensbury , New York 12801
2. CONTRACTOR or BUILDER 'S Name Sanitary Sewer Service
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3. CONTRACTOR or BUILDER 'S Address
P . O . Box 224
Glens Falls , New York aq
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4_ ARCHITECT'S Name ¢
[7. PLANS
HITECT'S Address
E of Construction — (Please indicate by X)
( ) Wood Frame i ) Masonry I ) Steel t l
and Specifications 1000 gallon septic tank , b hole dist . box and 125 ' m
leach field per plot and application wNo-osed Use cr
Sewage system for dwelling
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$ 10 . 00
PERMIT FEE PAID — THIS PERMIT EXPIRES April 9 19
(if a longer psri )d 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.)
19 87
Dated at the Town of Queensbury this 9 t April
SIGNED Q Day of p
SIGNED BY c for the Town of Queensbury
Building and Zoning Inspector
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APPLICATION FOR SEPTIC DIISPOSAL PER APR 8 1 IU /
BUILDING 4a C'QUE DEF'"
DATE f I I
LOCATION OF P OPERTY FOR INSTALLATION
Owner's Name: �_ ? � -- '� � _ Telephone: __. I �
Address: c, .,.�/ �A""� ry �y
Installer's Name: �' Telephone: 7 "I �`�
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one Fla 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 on . not require 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 Tank r� gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length Za 5:: feet
SEEPAGE PIT(S) : Number of -^ / Size each feet by feet
Size of stone to be used # f Depth or Thickness , /'e feet
IMPORTANT
...Ple ..__L.IST NEW EQUIPMENT TO BE INSTA.LI.ED
^- b � � 4'- Q Y' •y'� 'fir "-" �..�.
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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, the fields and/or drywells
13. 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 $2500006
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system , a new proposal must be submitted
to the Queensbury Building Department before further construction.
I have read the regaalations above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sevrage Disposal Crdinance.
Signature of responsible person:
Tate:
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . A GOOD PLACE TO LIVE
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- Own Of
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Bay 98
(}ee sbu y, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME_
LOCAT ION
PEf�MIT NOW
DATE �— _...
So TYPE - Sari . Loam - Clay
ired? YES i+10
percolation est Requ . �►
p,srcolation rate - Min/Inch
TypE of SYSTEM / Vol Aoo "
Absorption field , total length-4,A� �
Length of each trench
Depth of trenches
Size of gravel
SEEPAGE P1Ts4Nt ber of)
Size-
ft. X ft .
-
Gravel size S1ze TyPe
p=pING :
Bldg , to tank - -----
Tank. to di.st. box --�-�
Dist. box to f ield/YES NO Partial
Openings sealed .'
LOCATION/SEpARAT1(JN 5 : QLL f t.
Foundation to tank -ft .
Foundation to absorption
Absorp
Lion to lot line �~ft.
Separation of pits C&4 pROPERTY (circle one)
ON OF SYSTEMt Bide - Right side -
F nt Rear
2.
SYSTEM
APPROV ICES o
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g c7 ing In$pector
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SANITARY SEWER SERVICE
Division of G. P. Drellos, Inc.
53 FOURTH STREET GLENS FALLS, N . Y. 12801
TELEPHONE 792-7257 .......� ..._ _. . ..._
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