1987-367 BUILDING PERMIT
TOWN OF QUEENSBURY No. 87-367
WARREN COUNTY, NEW YORK
CD
PERMISSION is hereby granted to Ra onym d Rg -j t ev
OWNER of property located at 3Fuller Road Street, Road or Ave,
i
r�
in the Town of Queensbury, To Construct or place a Sewaize Alteration
at the above location in accordance to application together with plot plans and other information hereto filed and
u"
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
w
t. OWNER'S Address is RD # 2 Sox 226
Queensbury , New York 12801
2. CONTRACTOR or BUI LOER'S Name Sanitary Sewer Service
1�
3. CONTRACTOR or BUILDER'S Address
p . 0 . Box 224 0
w
Glens Falls , New 'York
m
4. ARCHITECT'S Name
5. ARCHITECT'S Address
1—+
6. TYPE of Construction — (Please indicate by X) 'ro
Fi
I ) Wood Frame { 1 Masonry { 1 Steel { ?
N
7. PLANS and specifications 8 rx8 r pre—cast seepage pit per plot and application
No.
$, Proposed Use
Sewage System for dwelling cn
ro
m
(lo
m
$ 10 00 PERMIT FEE PAID — THIS PERMIT EXPIRES June 19 1989 rs
a �
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Clusenstwry before the expiration date.) r+
N
6
Dated at the Town of Queensbury this 1�9th
, zz Day
/ofQ, June 1g $7
SIGNED BY // for the Town of Queensbury
Building and Zoning inspector
„r Jnuvn c► ueen3r3ury r
BUILDING and ZONING DEPARTMENT ��
Bay and Haviland Road, R. D. 1 Box 98
Queensbury, New York 12801 JUN b 1987/ ' 3
U--► I�.
- t
- / -- 3 BUIL.DINO& COUrE DEPT-
SEPTIC DISPOSAL PERMIT APPLICATION
Owner ' s Name_ 62K> AJ LEE 4 Tel 7 3 (1f�
Address e
Person/Firm installing system. �' '--
Number of bedrooms ( residential only)
Total daily flow ; ( compute @ 150val . per bedroom per day) _
Topographv : fis rolling - steep ( circle one) Dearee of slope $
Nature of soils : #igan4oV loam-clay- other- Depth ft .
Ground water= - at what depth? ft -
Bedrock or impervious material- -at what depth? ft .
Percolation Test Required - Rate min/ inch .
Domestic Water Supply Municipal - Well - other
IMPORTANT !!
On a separate piece of paper , submit a diagram of the proposed septic
system with all dimensions ; including distance from any structure ,
distance from property lines and distances from any domestic water '
supply or shore - line of lake , stream , pondorr wetlands . Include all
dimensions of the system itself .
Description of proposed system *
ACV
Septic tank sit an gal . u�A / s�
Tile field-- Length of each trenchl-1 ft . Total field_ ft .
Size of stone
Seepage Pit ( s ) Nu—m er� _/ Size ftX__,R!1fto Size of stone#
Any contractor , corporation , individual , Etc . , engaged in the
construction of a Sanitary Sewage Disposal System , who covers the
same before inspection , does not have an approved Permit , or varies
from the approved application , will be subject to a Penalty of $ 250
as provided for in Section 6 . 010 of the Town of Queensbury Sanitary
e Ordinance . > !%�,
Sig tune of Appl -i nd Date
0 / 86 and / vl
See tic System Inspections :
A . All applicationd for septic system installation ,
alteration or repair , as recrui red by the Town of
9ueensbury Sanitary Sewage Ordinance , shall be
submitted to the Huildina 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
H - NO system shall be covered. before .inspection and
approval by the Building inspector . Failure to
comply with this requirement may result in the
uncoveringr of the system by the installer and a
fine of up to $ 250 . 004
C . An approved copy of the plot plan shall be
availableepon the construction site . Failure
to produce said plot plan at time of inspection
may result in an immediate work stoppage .
t3 . 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 M`
Department before further construction .
�Jvwn v� '�eeeQnsE+ eerc�
BUILDING and ZONING DEPARTMENT
t Bay and Haviland Road, R. D. I Box 98
. 0ueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION �p
DATE �/ PERMIT NO. f7 7 ` 3 7
SOIL TYPE - Sand - Loam - C1aY -
Percolation Test Required? 'YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field , total length
Length of each trench
Depth of trenches
Size of gravel_
SEEPAGE ITS4Numbe of)
Size- ft. X ft. 4 2�
Gravel size
PIPING : Size jTYpe
Bldg * to tank
Tank to
Dist . box field/pit
openings sealed? YES No Partial
LOCATION/SEPARATIONS :
Foundation to tank
Foundation to absorption o t .
Absorption to lot line J Jr f t .
Separation pits - ft .
LOCATI S STEM Oil PROPERTY (circle one)
Front - Rear Left side - Right side -
C.`CMMENT
i
SYSTEM USE APPROVED YE NO
Buiydl 99Inspector
01/86 and vl
I �
Rot) t
sipnclo
I
3Dof
i
i
s
I
i
a