1987-274 BUILDING PERMIT
TOWN OF QUEENSBURY No. 87-274
WARREN COUNTYr NEW ''WORK
PERMISSION is hereby granted to
Homestead `tillage
OWNER of property located at Qzb Luzerne Road (Lots 38 and 39) Street, Road or Ave. x
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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 fit an ro
approved and in compliance with the Town of Queenshury Building and Zoning Ordinance,
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F2CONTR*ACTOR
WNERS Address is Luzerne road
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Queenshury , New York
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or BUILDER'S Name
Sanitary Sewer Service
3. CONTRACTOR or BUILDER 'S Address P . 0 . Box 224
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Glens Falls , New York m
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4. ARCHITECT'S Name "PC
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rS. ACHITECT'S Address
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PE of Construction — {Please indicate by X) p
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l ) Wood Frame i ) Masonry 1 ) steel
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FPLANSecifications
1000 gallon septic tank , 6 hole distm box and 2 6 ' x8 ' seepage
pits with #3 stone per plot and application
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Sewage system for mobile home dwellings va
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$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES 3r 19 19 89 rt
(if a longer period is required an application for an extension must be made to the Building and Toning inspector of the
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town of Queansbury 'before the expiration date.)
Dated at the Town of Queenshury this 19th Day of May 19 87
SIGNED BY for the Town of Queenshury
Building and Zoning Inspector
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APPLICATION FOR SEPTIC DISPOSAL PERMIf1G�
�IJ`t4�J1 MAY 18 1987
/ BUILDING ODE DEiPT'
DATE .— f ,� I � �'� ,�F ocr
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LOCATION OF PROPERTY FOR INSTALLATION �#
Owner's Name: ! � [; Telephone: / `
Address: + —O 7 5
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Installer's Name: Telephone:
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) i 6 Z5
Topographyy. circle one: la Rolling Steep Slope % of slope
Soil Nature: circle one: San Loam Clay Other / Depth: _ feet
Ground Water: At what depth? feet
Bedrock or Impervious Material: At what depth? feet
Percolation test: circle one: t required required J rate min. inch.
Domestic water supply: circle one: unicip Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM: Septic Tank IPA gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S) : Number of / Size each _ feet by ep feet
Size of stone to be used # _ / Depth or Thickness - feet
I M P O R T A N T
...please...I.IST NEW EQUIPMENT TO BE INSTALLED
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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
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. 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 regulations above agree t abide by these an all req mints
Of the 'Town of Queensbury Sanft Se age C?rd.inan
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 . . HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE
(30kLDING and ZONING DEPARTMENT
Bay and Hayiland Road, R.o- 1 Box 98
()ueensbury. New York 12801
SEPTIC DISPOSAL SYSTEM
N ECTION
NMIE .��
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LOCATION
PERMIT NO .
OA'1"E
and - Loam - Clay - 0
—
S011; TYPE ' t Required? YES -
Percolation _ Min/Inch
Percolation rate
TYPE of SYSTEM: total length
Absorption field .
Length of each trench
Depth of trenches
Size of graver
P ITS�#NUVLbe Of) _ ,�---
SEEPAGE ` -ft.
Size_ +�'—
Gravel size Size Typ�
P SP II3G : {�/r
Bldg . to tank —.�-~
Tank to dist . box �----
flist_ box to field/ ES NO Partial
openings sealed?
T,OC,Vr,ON/SEPARATI(3Qi S : /
Foundation to tank e!. ( -ft:
Foundation to absorpt crn
Absorption to lot linef
Separation O P:Lts PROPBRTY [circle one)
,A)CATIDN OF Right side
Front - Rear Left side
SYSTEM [,,E AppRoVED
YES [3O
Bux ,ding Inspector
O1/$6 ma v1
l _70w4n o f Reeensburs
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.Q. 1 Box 98
Oueensbury. New York 12801
SEPTIC DISPOSAL SYSTEM iiNSPECTION
LOGAT i flN
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DATE 't5_T PERMIT NO .�-4--�—
SOIL TYPE - - Loam Clay --
Percolation Test Required? YES N
Percolation rate - Min/Inch _
TYPE of SYSTEM :
Absorption fieldr total length
Length of each trench
Depth of trenches '
Size of gravel
SEEPAGE &1TS4NUHLber of)
Size- -- �({ ft. X fto _
Gravel. size //
PIPING :
Size TY
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Bldg _ to tank ^ --
Tank to disc . box c'
Distw box to field/
Openings sealed? ES NO Partial
LOCATION/'S FASARAT ION S
Foundation to tank IV F f t.
Foundation to absorption t -
Absorption to lot line ---" -
Separation of Pits t.
LOCATION OF SYSTEM ON PROP R one)
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Front - Rear - Left side Fdgirh ide
COMMENTS :
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SYSTEM USE APPROVED IY NO
Building Inspector
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