1987-566 BUILDING PERMIT
TOWN OF QUEENSBURY No. 87-566 �
WARREN COUNTY, NEW YORK
Sandra Maille Wood ( Stockwell) "
PERMISSION is hereby granted � ^'
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OWNER of property located at Luzerne Rd . Street, Road or Ave. �
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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 . OWNE R"S Address is
Bois 268 RD #3 w
Luzerne Rd . 0
Queensbury , N . Y . 12801 c
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2. CONTRACTOR or BUILDERS Name
Reliable Sewer Y
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3. CONTRACTOR or BUILDERS Address IE:
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4. ARCHITECT'S Name
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5, ARCHITECT'S Address
6. TYPE of Construction — (Please indicate by X)
( i wood Frame l S Masonry I ) Steel
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7. PLANS and Specifications M
42t total length 60 '
No_ 1000 gal tank , tale field each trench �.
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8, Proposed Use
AAXXXjL*H*Ag Sewage Alteration
$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES August 25 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 Queensbury before the expiration darts.)
Dated at the Town of Queensbury this 25th pay of August
79 87
SIGNED BY '74;� ;67Zej?6 ��.� .9'�sr/ for the Town of Queensbury
Building and Zoning inspector /�.
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APPLICATION FOR SEPTIC DISPOSAL PERMIT BILF�ft'[f .E ; . 0 � UE '
DATE /
LOCATION OF PROPERTY FOR INSTALLATION LA le
Owner's Name: E '^
Address:' ) !l r'�1tiG '/rp.►l .• ll_� >✓ r `r�5c+ l
Installer's Name: Telephone:
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Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom} ( Ch
Topography: circle one: Flat Rolling Steep Slope of slope GE
Soil Nature: circle one: and oam Clay Other / Depth: _ feet
Ground Water: At what depth? ,_, feet
Bedrock. or Impervious Material: At what depth? _ feet
Percolation test: circle one: not required required / rate min, inch.
Domestic water suupply_ circle one: unicipal Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM: Septic Tank 1 gal. {minimum size: 1 ,000 gal.}
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TILE FIELD: Each Trench feet / Total system length jy C7 feet
SEEPAGE PIT(S) : Number of / Size each feet by feet
Size of stone to be used # / Depth or Thickness _ __ feet
IMPORTANT
_._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, 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 Queensbu -y Sanitary Sewage Disposal Ordinance.
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
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BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D_ 1 Box 98
C � Queensbury, New York 12801
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tdfi Fvll�r SEPTIC DISPOSAL SYSTEM INSPECTION
NAME S / '�tt'°+c( lRl
LOCAT I GN_ #
DATE PERMIT NO .
SOIL TYPE - and - Loam - Clay -_
Percolation Test Required? YES - NO
Percolation rate - Min/Inch _
TYPE of SYSTEM :
Absorption field , total length S� __
Length of each trench :54E:s
Depth of trenches o 4 Jf
Size of gravel WT. -
SEEPAGE P umber o 4 __ _
Size- ft. X
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vel 5iz
PIPING : Size Type
Bldg , to tank - -'
Tank to a box
D i s x to f ' /Pit 1--
enings ed? "�' NO Partial
LOCATION/SEPARATIONS :
Foundation to tank ft.
Foundation to absorption f 0 f::� _
Absorption to lot line Eft
Separation of pits f
LOCATION GE SYSTEM ON PROpERTY (circle one)
Front - Ea - Left side - Right side
CGMMENTS :
Or 5 r- 3v ac
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SYSTEM USE APPROV:i.34ild1ncjInspe
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