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1987-130 BUILDING PERMIT TOWN OF QUEENSBURY No. 87-130 WARREN COUNTY, NEW YORK n. Richard Goedert w D PERMISSION is hereby granted to c a.. 11 Centennial Drive Street. Road or Ave. t7 OWNER of property located at v Sewage Alteration P+ in the Town of Queensbury, To Construct or place a "' rS at the above location in accordance to application together with plot plans and other information hereto filed and r � approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. 1 . OWNER'S Address is 11 Centennial Drive Queensbury , New York 12801 t✓ 2. CONTRACTOR or BUILDER'S Name Sanitary Sewer Service rt ro 3. CONTRACTOR or BU1LDEWS Address D' F' . © . Box Glens Falls , New York GI �s W 4. ARCHITECT'S Name 5. ARCHITECT'S Address 6. TYPE of Construction — (Please Indicate by XI ( ) Wood Frame ( ) Masonry l ) Steel i 1 us m A7_ PLANS and Specifications ion 1 - 6 hole d1sto box and 2 - 6 ' x8 ' drywells per plot and applic CD No. rr rC rt 8_ Proposed Use N Sewage System for dwelling a 0 10 . 00 April 9 19 89 � PERMIT FEE PAID - THIS PERMIT EXPIRES , (If a longer period is reciuWed an application for an extension must be made to the auilding and Zoning inspector of the town of Clueensbury before the expiration date.) Eated at the Town of Queensbury this 9th Day of _ April 19 87 SIGNED BY for the Town of Queensbury Buildlog and Zoning Inspector CT f O1N N G F r. ' ! nD APPLICATION FOR SEPTIC DISPOSAL PERb11WU PR fin } / ij0 � r � / f �-+ BUILDING 6c CODE OEPT, BATE 1 / LOCATION OF PROPERTY FOR INSTALLATION Owner's Name. -e d7'Pk Telephone: f Address: . Installers Name: Y( J T / Telephone: d Number of bedrooms (residential only) .,__ Total daily flow (compute @ 150 gal per bedroom) �U Topographyz circle one. lat Rolling Steep Slope % of slope Soil Natures circle one: Loam Clay Clther { Depth: feet Ground Water: At what depth? feet Bedrock or Impervious Material: At what depth? feet Percolation test: circle one: OEEiequire required { rate min. inch. Domestic water supply: circle one: <1unicipai�> Well Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorption _ feet PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1,000 gal.) TILE FIELD]: Each Trench _ -- feet / Total system length feet SEEPAGE PiT(S) : Na-amber of �- / Size each J�^ feet by _� feet Size of stone to be used # _ { Depth or Thickness 2_ feet IMPORTANT ...Please...IAST NEW EQUIPMENT TO BE INSTALLED (over) Section I1 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 trust be submitted to the Queensbury Building Department before further construction. I have read the regulations above and agree to abide by these aad all requirements of the Town of Quueenebury Sanitary Sewage Disposal Ordinance. Signature of responsible person: Date: "Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1763 . . . !-TOME OF NATURAL BEAUTY . . A GOOD- PLACE TO LIVE 70tvn of "ee" 31"ry BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.G. 1 Sox 98 Queensbury. New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME t c +' (22A Oh LOCATION � 1 C�?•+� : �y� .t Cc- 'C.. `�•. DATE / Au I T No . - o- SOIL TYPE - an -- Loam - Clay - Percolation est Required? 'YES - NO Percolation rate - min/inch _ TYPE of SYSTEMS: Absorption field , total length Length of each trench Depth of trenches Size of gravel_ SEEPAGE {Numb ft) Slze Gravel-size PIPING : Size Type Bldg , to tank #-s..K- --- G - Tank to disc. box Dist. box to field/ Openings sealed? reS NO Partial IOCATION/SEPARATION S - Foundation to tank r0�£t.dF Foundation to absorption ft . Absorption to lot line 10 ft-- Separation of pits �f t. r,cx�nTl YSTE4 ON PROPERTY (circle one) Front ea - Left side - Right Side - COMMEN SYSTEM. USE APPROVED ES NO wk3 Bujldjjrg Inspector 01/86 and vl SANITARY SEWER SERVICE Division of G. P. Drellos, Inc. 53 FOURTH STREET GLENS FALLS, N . Y. 12801 TELEPHONE 792-7257 I � 4 \ C j13 O 00 F1 1 1 v s i