1987-373 BUILDING PERMIT
TOWN OF +QUEENSBURY No 87-373 �
WARREN COUNTY, NEW YORK
Robert Benton 1
PERMISSION is hereby grant to i
OWNER of property located at
Burch Rd . & Dean Drive Street, Road or Ave.
Sewage Alteration
in the Town of Queensbur
y, To Construct or place a
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 Queensbury Building and Zoning Ordinance. a
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t . OWNER% Address is
Corner Burch Rd . & Dean Drive
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Queensbury , N . Y . 12801 n
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2. CONTRACTOR or BUILDERS Name
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3. CONTRACTOR or BUILDER'S Address a'
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4. ARCHITECT'S Name
5_ ARCHITECT'S Address a
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6. TYPE of Construction — (Please indicate by X) [D
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4 ) wood Frame i ) masonry I 1 Steel I )
7. PLANS and Specifications rn
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No- 1000 gal . tank. 6 1 8 ' x 8 ' seepage pit per application
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B. Proposed Use
Sewage system for a dwelling '
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10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES June 89
19$
[If a longer period is required an application for an extension must be made to the Building aril Zoning inspector of the
town of Queensbury before the axpi rat ion date.)
Dated at the Town of Queensbury this 22nd Day of `tune 19 87
SIGNED BY 4 for the Town of Queensbury
Building and Zoning Inspector
TOWN %3
APPLICATION FOR SEPTIC DISPOSAL PERMIT D , $ 13' ,
JUN 161987 `W
DATE /f Lf / f ,E f17 P GG7
LOCATION OF PROPERTY FOR I{{NST'ALATION
Owner's Name: _ r I. rl"/7l�A' Telephone: _
Address: �^
Installer's Name: .S G' T ._ Telephone:
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) ,
Topography: circle on@epth?
Rolling Steep Slope °.o of slope
Sail Nature: circle onLoam Clay Other J Depth: feet
Ground Water: At wh � feet
Bedrock or Impervious Material: At what depth? _ feet
Percolation test: circle one hot required required J rate min. inch.
Domestic water snpplyo circle one unicipal ell Other
IF domestic water supply is a
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM. Septic Tank _�� gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet J Total system length feet /�
SEEPAGE PITi(S) . Number of ^ J Size each .feet by feet �,r `�t--�
Size of stone to be used # / Depth or Thickness _ feet
IMPORTANT
...Pleass...LIST NEW EQUIPMENT TO BE INSTALLED
(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
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 regulations above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage Disposal Ordinance,
Signature of responsible person:
Date:
Town of Queensbury
Building and Code Department
Bay at Haviiand Road
Queensbury, New York 12801
(518) 792-5832
SE 'PTLED 1763 HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE
TOO