1987-532 BUILDING PERMIT
TOWN OF QUEENSBURY No $�-� 3� �
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Sam Bad za a
OWNER of property located at Birch Lane Street, Road or Ave. `o
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in the Town of Queensbury, To Construct or place a Sewage Alteration w
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
Seacomm Plaza
Box 6
Pottsdam , N . Y . 13676
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2. CONTRACTOR or BUI LDERS Name
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Sanitary Sewer
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3_ CONTRACTOR or BUI LDER'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 ) masonry i ) Steel ( 1
7_ PLANS and Specifications
No. 1000 Gallon Septic tank , distribution box and 2 6 ' x 8 ' dry wells
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per plot plan and application . CD
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B. Proposed Use
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Sewage Alterationrt
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10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES August 14 , f9 89 0
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(If a longer period is required an application for an extension must be made to the Building and ?coning inspector of the
town of Oueenslaury before the expiration date.)
Dated at the Town of Queensbury this 14th DayJ of August 19 87
SIGNED BY /� f e�- for the Town of Queensbury
Building and Zoning Inspector Oe
APPLICATION FOR SEPTIC DISPOSAL PERMIT
AUG 10 7��f
r ✓ . BUILDING CODE DEPT.
DATE rlI ►� SL! � ?r { , G/ - t
LOCATION OF PROPERTY FOR INSTALLATION I /.�+L�.. 0
Owner's Name : � tq S 2, A Telephone:
Address: IO3t Syr Or t�3C" A+^�'1 IU•� ' +�
Installer's Name: j rf&,rjAjeK
'Telephone: 7J. S "'7
Number of bedrooms (residential only) �...7
Total daily flow (compute @ 150 gal per bedroom) .T
Topography: circle one: tat Rolling Steep Slope % of slope _
Soil Nature: circle one: < and Loam Clay Other / Depth: _ feet
Ground Water: At what depth? feet
Bedrock or Impervious Material: At what depth? _ --� feet
Percolation test•ft circle one: not require required / rate min. inch.
Domestic water supply: circle one: lcmunicipal Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption _ feet
PROPOSED SYSTEM: Septic Tank 0 a gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length -- feet
SEEPAGE PIT(S) ; Number of / Size each 0.0_^ feet by feet
Size of stone to be used # / Depth or Thickness - feet
IMPORTANT
...Please...LIST 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 $250.00.
co An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building .Department before further construction.
I have read the regulations above and agree to abide by these and all req■■* ements
of the Town of Queensbury Sani a Disposal Ordinau
Signature of responsible a person:
Date: `)
Town of Queensbury
Building and Code Department
Bay at Haviland road
Queensbury, New York 12801
(518) 742-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD PLACE T4 LIVE
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_lawn o� '�ueen .s6e+rs�
rr BUILDING and ZONING 'DEPARTMENT
Bay and Haviiand Road. R. D. 1 Box 98
oueensbury. New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCAT I
DATE PERMIT
SOIL
SOIL TYPE - Sand - Loam - Clay -
Percolation Test. Reguired? YES - NO
Percolation rate - lain/inch. ,
TYPE of SYSTEM:
Absorption fieldr total length
Length of each trench
Depth of trenches '
Size of gravel
SEEPAGE iTS4Nuinber f )
Size- Z ft- X ft.
Gravel size
PIPING : Size Tglf�
Bldg . to tank --� --
Tank to clist . box
Dist. box to field/ {
Openings sealed'? E:S NO Partial
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LOCATION/sEF"ARATIONS : of t.
Foundation to tank
Foundation to absorption jft.
Absorption to lot line iS ft .
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Separation of Pits f
I��,TIpN SYSTEM ON PROPE$ (circle. one)
Front ar, Left side R1t side -
CC HMENTS
SYSTEM USE: APPROVED, 17CF5 ` 1 NO
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Bui inspector
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