1987-235 BUILDING PERMIT
TOWN My N OF QV EENSBU t I Na $7-235
' l j';� _ W/ r ) n WARREN COUNTY, NEW YORK
PERMISSION is herebLyy granted to Randy Freeman
OWNER of property located at 12 Zenas Drive Street, Read or Ave.
in the Town of Queensbury, place a Sewage .Alteration
To Construct or p
at the above location in accordance to application together with plot plans and other information hereto filed and �C
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. fty
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1 . OWNER'S Address is 12 Zenas Drive
Queensbury , New York 12801 P1
2. CONTRACTOR or BUILDER'S Name
Jay Sweet
Queensbury Sewer Service
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3. CONTRACTOR or BUILDERS Address �
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d. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction — {Please indicate by X1 pry
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1 Wood Frame { ) Masonry { 1 Steel ( )
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7. PLANS and Specifications r(DI
Dist . Box and 180 ' leach field per application r�r
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8. Proposed Use
Sewage system for dwelling
$ 10 . 00 PERMIT FEE PAID - THIS PERMIT EXPIRES May 11 1989
(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_)
Dated at the Town of Queensbury this llth �,D, ay of May1g 87
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SIGNED BY '?i a, for the Town of Queensbury
Building and Zoning I nspector
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'rowN OF
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APPLICAT70N FOR SEPTIC DISPOSAL PERMIT' MA I 8 19
/ a _"b Ir � c A `71
BUILDING $r CODE DEPT,
DATE 7 �1
LOCATION OF.-P OPERTY FOR IN TALLATION
Owner's Name: T ?.y �T Telephone: _
Address: / � ►t �,<__,..., c; i- 7
Installer's Name: !� 4, - Telephone: .XC '
Number of bedrooms (residential only*)
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one: at Rolling Steep Slope % of slope
Seal Natures circle one: Sand Loam Clay Other j Depth: feet
Ground Water: At what depth? , - feet
Bedrock or Impervious Materials At what depth? � feet
Percolation test: circle one: not requir6 required / rate min. inch.
Domestic water supplys circle one• v unicipal Well Other
IF domestic water supply is a Weil:
Separation: Watersupply from Septic absorption _ feet
PROPOSED SYSTEM : Septic Tank,/ ,?r n ____ gal. (minimum size. 1 ,000 ,gal.)
TILE FIELI]I Each Trench feet j Total system length feet
SEEPAGE PIT(S) : Number of / Size each feet by feet
Size of stone to be used # _ / Depth or Thickness 2., feet
* * * s s * * s s * * * * * s * s * s s * * * * * * * * * s * sae * * * * s s
IMPORTANT'
...Please*..LIST NEW EQU PMENT TO BE INSTAIJ.&D
* * * * * * * * s * s * * * * * s s s s s s * s s * s s * s s s * s * se * * * s
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(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
54) 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 $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may result
in an immediate work. stoppage.
D, Sbould unforeseen problems during construction prevent proper, installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
I have read the regulations above and agree to abide by these and all requirements
of the Toren of Queensbury 'Sanitary Sewage Disposal Ordinance.
Signature of responsible person.
Dates It fi t f �S 7
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD. PLACE TO LIVE
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BUILDING and ZONING DEPARTMENT
SOY and Havij&nd Road.OueenShuryj New York� 4X 9$
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SEPTIC DISPOSAL SYSTe4 INSPECTION
IJAME
LOCATIONe � .Z
BATE '�"T
Laaam - Clay
SOIL TYPE a fired? YES
percolation Test Reclti .
Percolation rate ]Ain/Inch
TYPE of SY'STEml / V
Absorption field , total length
Length of each trench U
Depth of trenChe a -----~-
Size of gravel.,
SEEPAGE PITS#lsumber off!
Size_
Gravel size Size IYPe
pIP TING
Bldg . to tank. _�--
Tank to dirt. box ��-
Dist, box to field Partial
Openings sealed? YE
NO
j=ATI0I3/SEpAFAT:E0NS : K i f t.
Foundation to tank ,d ft .
Foundation to absorPtion
t.
Absorption to lot line �. ft.
Separation of pits pRQPERTY (c� rcle one)
VATI YS`Lef QI3
Front ea - Left side - Right side
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SYSTEM USE APPROVED ES NO
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Building Inspector
01/86 and vl
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