1987-563 BUILDING PERMIT
TOWN OF +QUEENSBUR.Y No. 87-563
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WARREN COUNTY, NEW YORK c7
PERMISSION is hereby granted to Thomas Bridge I
A
i
zerne Rd .
OWNER of property located at Lu Street, Road or Ave,
To Construct or lace a Sewage Alteration
in the Town of Queensbury, P
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.
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1 . OWNER'S Address is
of
Luzerne Rd . W
Queensbury . N . Y . 12801
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2. CONTRACTOR or BUI LDERS Name �
Reliable Sewer Service
a CONTRACTOR or BUILDERS Address lt
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4, ARCHITECT'S Name
5. ARCHITECT'S Address
6_ TYPE of Construction — (Ple indicate by X) C
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I 1 Wood Frame I 1 Masonry { 1 Steel
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7. PLANS and Specifications I--'
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No_ 1000 gal septic tank , seepage pits ( 2 ) 6 ' x 8 ' each as per plot plan
and application . I'Y
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S. Proposed Use
Sewage Alteration to one family
10 . 00 August 24 , 89
$ PERMIT FEE PAID — THIS PERMIT EXPIRES 19
[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 data.!
Dated at the Town of Queensbury this 24th Day of
August 79 87
SIGNED BY Cam_' for the Town of Queensbury
Building and Zoning Inspector
. .
APPLICATION FOR SEPTIC DISPOSAL PERMIT BUFLOiNc .z ;-00E C)EP"
DATE /
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: y T77 a!!nz if Telephone:
Address:
Installer's Name: Telephone:
Number of bedrooms (residential only) _e _
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one. Flat Rolling. Steep Slope %n of slope
Soil Nature: circle one: San Loam Clay Other { Depth: _ feet
Ground Water: At what depth? L feet
Bedrock or Impervious Material: At what depth? feet
Percolation test: circle one; not required required / rate min, inch.
Domestic water supply: circle one: unicipal Well Other
IF domestic water supply is a Weil:
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM : Septic Tank /(� C7p gal. (minimum size: 1.,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S) o Number of { Size each feet by 'r feet
Size of stone to be used # { Depth or Thickness r7 feet
IMPORTANT
...Please...LIST NEW EQUIPMENT TO BE INSTALLED
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
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Section Il 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
Be 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.
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 he submitted
to the Queensbury Building Department before further construction.
1 have read the regulations above and agree to abide by these and all requirements
of the *town of Queensbury Sanitairy Sewage Disposal Ckxlinance.
Signature of reIsponsible person;
Date: ,/r
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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iJi� �O4tvn 0/ Queerij ury
BUILDING and ZONING DEPARTMENT
} F• ih IFi Stay and Haviland Road, R-D. 1 Box 98
Oueensbury. New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION ?
DATE �fY7 PERMIT 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 PITS4NUMb,.�,,r/of) _
Size- fto X _7 fto
Gravel size
PIPING : Size. T e
Bldg . to tank 4 �''� C
Tank to dirt . box
Dist. box to fieldPyEs!nw
Openings sealed? d I Partial
LO CATIOW/SEPA =ONS =
Foundation to tank �t-
Foundati.on to absorptionft -
Absorption to lot line -t" ft .
Separation of pits 'Ojz� fto
LOCATION OF SYSTEM ON PROPERTYht " rclde one)
Front - Rear - Left side: g
COMMENTS :
SYSTEM USE APPROVED E N
Building Inspector
01/86 and vl
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