1987-309 BUILDING PERMIT
TOWN OF QUEENSBURY No. 87_309
WARREN COUNTY, NEW YO'RK
PERMISSION is hereby granted to Daru&ld Ga A
OWNER of property located at =Lwalab stlerlr Ave Street, Road or Ave.
in the Town of Queensbury, To Construct or place a 5atgg" Altsrat3. u
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 Oueensbury Building and Zoning Ordinance.
1. O N E R'S Address is
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Q aJwAx ►s Now Tork 12=1
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2. CONTRACTOR or BUI LDE RS Name
Qlplaal�siratc�► Salvar r.
3. CONTRACTOR or BUILDER'SAddress
Lake Goolum s In&w Totrk �
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4. ARCHITECT'S Name 'p�ta
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5. ARCHITECT'S Address
6. TYPE of Construction — (Please Irxdicate by X)
I ? Wood Frame { ) Masonry I ) Steel { )
7. PLANS and Specifications
IWO talsk.e dish . %os a & 190* tilt fiaa3d par plot and
No. alil.*+1►ti+�i1
S. Proposed Use Saw*&* syat� for K3imll#'I+Is.�`�r
S 10'04) PERMIT FEE PAID — THIS PERMIT EXPIRES .7IM" 2 19 89
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Chmansbury before yse expiration data.)
Dated at the Town of Queensbury then y2xid Day of Jtalaa 19 87
SIGNED BY 1br the Town of Queensbury
Building and Zoning I napsctor 1
�..1►omeZ df Gee 40vy TOWN OF QUEENSii ii%5 Y
APPLICATION FOR SEPTIC DISPOSAL PERMI'i' L�, l V, I +,'J N
MAY 2 9 1987
BUILDING IV DEPT.
DATE �f �L/ f � iE.- C�c,
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name -j�_Y,..� r, Q � Telephone:
Address: _
Installer's Name: Telephone:
Number of bedrooms (residential only)
Total daily flow (compute (9 150 gal per bedroom)
Topography: circle one: lat Rolling Steep Slope % of slope
Soil Nature: circle one Loam Clay Other / Depth: feet
Ground Water: At what depth? 14 feet
Bedrock. or Impervious Material: At what depth? feet
Percolation test: circle one not require required / rate min. inch.
Domestic water supply: circle one< Municipal) Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption _ feet
PROPOSED SYSTEM: Septic Tank ,/e'e Z> gal. (minimum size: 1 ,000 gal.)
Z, c) . S ,� �'TILE FIELD: Each Trench �S = 3� feet / Total system length �.--C�� feet
SEEPAGE PIT(S) v. Number of / Size each feet by feet
Size of stone to be used # _ / Depth or Thickness feet
IMPORTANT
aa.Please...LIST NEW EQUIPMENT TO BE INSTALLED
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
p : r - Y
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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
Z.) 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.
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 regulatiorm above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage Disposal Or4linance.
Signature of responsible person: .-
Pate: Jam"''
i
"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
Town o31k'E�Iis� ftl^L�
BUILDING and ZONING OEPARTMENT
Say and Haviland Road, R-r-). 1 Sox 98
Coueensbury, New 'York 12801
SEPTIC DISPOSAL. SYSTEM INSPECTION
NAhM1E
L.00AT ON
DATE PERMIT NO. �
SOIL TYPE S n Loam - Clay
t Re ired? YESs^� O
Percolation Tea
Min/Inch J�
Percolation rate - Min/Inch
TTI of SYSTEM: toEa1 length
Absorption field , tal s
Length of each trenc
Depth of trenches
size of gravel
SEEPAGE PITSENumher of)
Size- ft. 'X
Gravel Size ' Si ze III 'Type !�
PIPING :
Bldg , to tank.
Tank to disc . box
Dist. box to field/ NO Partial
Openings sealed? ES
LOCATIOU/SEPARATIONS = / ft.
Foundation to tank absorption t .
Foundation to ft :�
Absorption to lot line ft.
Separation of pits
LOCATION STEM ON PROPERTY
(Circle one)
Front ear -Left side - Right side -
CCM41BN
SYSTEM USE APPROVE YES NO
Building Inspector
01/86 and vl
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