1987-561 BUILDING PERMIT �
TOWN OF QUEENSBURY
No. 87-561
�j WARREN COUNTY, NEW YORK
Dr . Richard Leach
PERMISSION is hereby granted to
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r _ Ridge r�
OWNER of property located at Street r Road or Ave. w
in the Town of Q.ueensburyA 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 Oueensbury Building and Zoning Ordinance.
1 , OWNE R'S Address is
Ridge Rd . ti
Queensbury , N . Y . 12801 I
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2. CONTRACTOR or 130 LOE R'S Name n
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Sanitary Sewer rt
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3. CONTRACTOR or BUILDER 'S Address
4. ARCHITECT'S Name
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5. ARCHITECT"S Address
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6. TYPE of Construction — (Please indicate by X)
[ ) Wood Frame I l Masonry I ) Steel I I
7. PLANS and Specifications
No. Septic tank -- 1000 gal. . Seepage Pit - 1 6 ' x 8 '
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8. Proposed Use w
Sewage Alteration
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$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES August 2G 19 89
0f a longer period is required an application for an extension must be made to the Bu lid 1ng and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Gueensbury this 24th Day of August 19 87
SIGNED BY '45:'>,�� for the Town of Queensbury
Building and Zoning I nspector
f� APPIACA717ON FOR SEPTIC DISPOSAL PERMIT
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DATE �'""�' V� � � I lT !� BiJ/ I w}E C►EPT
LOCATION OF PROPERTY FOR INSTALLATION
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Owners Name :{ ��
' V'k c6A riD Telephone: �7 ,,.j
Address: — A Q-1•(
Installer's Name: U1, - IU 7-J� fL,Ct C� � Telephone:
Number of bedrooms (residential only)
Total daily flow (compute (KP 150 gal per bedroom)
Topography: circle one Fla Rolling Steep Slope of slope _
Soil Nature: circle one; Clay Other / I3epth: feet
Cwound Water: At what 1,depth? feet
Bedrock or Impervious Material: At what depth? --�^"' feet
Percolation testa circle one: not required required / rate min. inch.
Domestic water supply: circle one: Municipal ICWelI then
IF domestic water supply is a Well:
Separation: C
Water-supply from Septic absorption _ )— feet
PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S) : Number of / Size each feet by d'` feet
Size of stone to be used # < / Depth or Thickness 2,� feet
IMPORTANT
...Please...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.
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.
1 have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbury Sant wage Disposal Ord' ce.
Signature of r sponsi le 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
`7. o/ Queenig"ry
BUILDING and ZONING DEPARTMENT
Bay and Hauiiand Road. R. D. 1 Box 98
Clueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCAPPE
t
DATEl ERMIT NO ,
SOIL - ' Sand - Loam - Clay -
Percolation Test Required? YES - N0
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field , total length
Length of each trench
Depth of trenches
Size of gravel_
SEEPAGE PITS4Numbe of)
---
Size- ft. x __ ft .
Gravel Aze
PIPING : Size Type
Bldg . to tank ---� Yc
Tank to diet. box e � c
Dist. box to field , yc - - -
Openingrs sealed? YES O artial
LOCATION/SEPARATIONS :
Foundation to tank L4' _ft.
Foundation to absorption ft .
Absorption to lot lineft .
Separation of pits ft.
LOCATION OF SYS=229== ARTY (circle one)
Front - Rea Left side Right Sid
COMMENTS : - a n7 � fPxv.
SYSTEM USE APPROVED YES O
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