1987-344 BUILDING PERMIT
TOWN OF QUEENSBURY No 87-344 �
WARREN COUNTY, NEW YORK
} Gary an Carol Chadwick o
PERMISSION is hereby � d.granted to
OWNER of property located at 34 Arbutus Drive Street, Road or Ave.
1
in the Town of Queensbury, To Construct or place a Sewage Alteration
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.
1 . OWNER'S Address is
34 Arbutus Drive B-46
RD #3
Queensbury , New York
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2. CONTRACTOR or BUILDER'S Name �
Andy Scarpellino
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3. CONTRACTOR or BUILDER'S Address
4 Seward Ave .
Glens Falls , New York 12801
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d. ARCHITECT'S Name phi
£5+
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S. ARCHITECT'S Address
S. TYPE of Construction — (Please indicate by X) i
F-
f ) Yvood Frame i ) Masonry I ) Steel ( I
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7. PLANS and Specifications C
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seepage pits #3 stone 1 ft . thick per plot and application �
No. , T--- y
I3. Proposed Use
Sewage system for dwelling
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$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES June 11 19 89
ury
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the m
town of Queensbury before the expiration date.) y
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Dated at the Town of Queenshury this 1 th Day of June 19 87
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SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
TOWN O'
APPLICATION FOR SEPTIC DISPOSAL PERMIT UU JUN 111987
BUILDING a CODE DEPT.
DATE /
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: [ c . Telephone: � 7 `v ^,
Address:
Installer's Name: Telephone:
AT
Number of bedrooms (residential only)
Total daily flow (compute (LD 150 gal per bedroom) ^�
Topagrapphy: circle one: Flat Rolling Steep Slope % of slope
Sail Native: circle one: and Loam Clay Other . / Depth: feet
Ground Water: At what depth? U feet
Bedrock. or Impervious Material: At what depth? feet
Percolation test: circle one: not required required / rate ti min, inch.
Domestic water supply: circle one ici Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM: Septic Tank /Ga y gal. (minimum size: 1 ,000 gal.) 4�!- G
TILE FIELD: Each Trench feet / Total system length feet
/VC42EEPAGE PIT(S) : Number of � / Size each feet by feet
Size of stone to be used # Depth or Thickness feat
IMPORTANT
..=Please.oeUST 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 Queensbuuy 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 $Z50.00.
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. 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.
l 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: ,� '� G�f• �?�`^
Date: 6 /ram
Town of Queensbury
Building and Code Department
Bay at Haviiand Road
Queensbury, New York 12801
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . A GOOD. PLACE TO LIVE
. � 709V4" 0/
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
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NAME
LOCATION
DATE /..Ifol PERMIT NO.
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation .Kate - Min/Inch
TYPE of SYSTEM;
Absorption field , total length
Nk
Length of each trench
Depth of trenches
Size of gravel_
SEEPAGE PITS4Number of)
Size- ft. X _ ft .
Gravel size
PIPING : Size Type
Bldg . to tank
Tank to dist_ box
Dist. box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONSt
Foundation to tank ft.
Foundation to absorption ft ,
Absorption to lot line ft .
Separation of pits ft.
F nt ea SYSTEM ON de - Right side one)
F nt Rear - Left side - Right side -
7
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SYSTEM USE APPROVED YES NO
Buildi g Inspector
01/86 and v1
_town v QUeen .fhury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road. R. D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DUSPOS4L SYSTEM INSPECTION
r
NAME
LOCAT rI ON '
DATE W !2 PERMIT NO.
SOIL TYPE - Sand - Loam - clay -
Percalation 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 PITS4Number of )
Size- ft. X _ ft .
Gravel size
PIPING : Size Type
Bldg . to tank
Tank to dirt . box
Dist . box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS :
Foundation to tank ft.
Foundation to absorption ft .
Absorption to lot line £t .
Separation of pits ft.
LOCATION OF SYSTEM 'ON PROPERTY (circle one )
Front - Rear - Left side - Right side -
COMN TENTS : f } >]
r3
SYSTEM USE APPROVED YES NO
Build ' g Inspector
01/86 and vl
_Down v liven 36urc� J
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAM
LOCATIONw�
Oa TAA'4�//'�, ^y am/ (/ [
,DATE (Cr / c? ' -+ PERMIT NO* ILL, 4�Y
SOTL TYPE - Sand - Loam - Clay -
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 P TS4Number f)
size- ft. X ft . L �—.
Gravel s ze
PIPING : S '' z Type
Bldg . to tank I S1"
Tank to dist_ box
Dist. box to fiel
Openings sealed? 007c!NO ' Partial
LOCATION/SEPARATIONS :
Foundation to tank
Foundation to absorption �,.ft .
Absorption to lot line ft .
Separation of pits &Q ft.
OF SYSTEM. ON PROPERTY (circle one )
Front Rear - Leftside - Right side -
s S /]
: 1 5 C IO,
SYSTEM USE APPROVEAding
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Bnso rector
01 /86 and vl
BUILDING and ZONING DEPARTMENT
Bay and Haviiand Road, R, D, 1 Sox 98
Oueensbury, New York 12801
SEPTIC . DISP4 L Zj7
TEM SPELTION
NAME LA
L C C
LOCATION 3 `L'
DATE �r /jj7PEPMIT NO.
SOIL TYPE - Sand - Loam - Clay -
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 PITS414umber of) _
Size-- ft , X ft_
Gravel size
PIPING : 'Size Type
Bldg . to tank
Tank to dist. box
Dist= box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS -
Foundation to tank ft_
Foundation to absorption ft "
Absorption to lot line ft .
Separation of pits ft.
1 ON OF SYSTEM ON PROPERTY (circle one )
ion - Rear - Left side - Right side -
ENTS :
SYSTEM USE APPROVED YES NO
Building Inspector
01/86 and vl
r
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL
/�SYST INSPECTION
�E- 1 ,C jo COW
LOCATION ,.s 4rrj
DATE /I t / PERMIT NO.T��I,�
Sand - L.aam - Clay -
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 P ITS4Nuinh Of) —`
Size- X - ft.
Gravel size
-PIPING : Size Type
Bldg . to tank
Tank to disc. box
Dist. box to field/pit �
Openings. sealed? YES NO Partial
LOCATION/SEPARATIONS :
Foundation to tank ft.
Foundation to absorption fte
Absorption to lot line ft.
Separation of pits ft�
LOCATION OF SYSTEM Chi PROPERTY (circle one)
Front - Rear - Left side - Right side -
CCHMENTS :
jt.- d e�"
71-71
SYSTEM USE APPROVED YES NO
BuirdIng inspector
01/96 and vl
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