1987-641 BUILDING PERMIT �
TOWN OF QUEENSBURY �
No. 87-641 �
��'yy' WARREN COUNTY, NEW YORK
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Pete Dastalto
PERMISSION is hereby granted to 1
' 1Pinewood Road Street, Road or Ave.
OWNER of property located at
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.
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f . OWNER'SAddressis Pinewood Rd . ro
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Queensbury , N . Y . 12801 i°
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2. CONTRACTOR or BUI LDE R'S Name
Sanitary Sewers a
3. CONTRACTOR or BUILDER'S Address
P . O . Box 224
Glens Falls , N . Y . 12801
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4. ARCHITECT'S Name (D
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5_ ARCHITECT'S Address ra
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6. TYPE of Construction — IPlease indicate by X)
I ) Wood Frame I ) Masonry I 1 Steel { )
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]. PLANS and Specifications p,
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No. Existing 1000 Tank , Distribution Box 2- 6 ' x8t dry wells m
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a_ Proposed Use
Sewage alteration
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g 10 . 00 PERMIT FEE PAID - THIS PERMIT EXPIRES Sept . 23 , 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 date.)
Dated at the Town of Queensbury this ,.y23rd Day of Sept 19 87
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector �//�
1AM OWn rowN OF cruEE s , _` .
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APPLICATION FOR SEPTIC DISPOSAL PER. T S EP 2 31987
0 E3U],"D;r4G CODE DEPT.
DATE r `T
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name; l �` 6 -- T 0 Telephone: �f
Address: �`�2. r_s� ' K_ ( �+ C�
Installer's Name: �) r T+f�1R ( `-� L � � V2 Telephone: � 6i �
Plumber of Bedrooms (residential only) _
Total daily flow (compute @ 150 gal per Bedroom)
Topography&. circle one: Rolling Steep Slope of slope
Soil Nature: circle one: an Loam Clay Other / Depth: feet
Ground Water: At what depth? feet
Bedrock or Impervious MatPxial: At what depth? feet
Percolation test: circle one: of required required / rate min, inch.
Domestic water supply: circle one:<25u Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic bsorption _ feet
J e0EXIS7" Inf
PROPOSED SYSTEM: Septic Tank 1 gal. (miniman size: 1,000 gal.)
TILE FIELD: Each Trench feet / Total system length '� feet
SEEPAGE PIT(S) : Number of / Size each , feet by feet `.
Size of stone to be used it / Depth or Thickness J- feet y•'
IMIP0RTANT
....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.
I have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary age Disprosal. Ordinance.
Signature of responsible person:
Date: �� � ✓�
Town of Queensbury
Building and Code Department
.Bay at Haviland Road
Queensbury, New York 12801
(518) 79z-5832
SETTLED 1763 _ HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LWE
awn O/ Queen .1i"ry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R, D. 1 Sox 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME CJ l4 fa ` -I'o
LOCATION !'r�1(°.:wW:: ;r C"
DATE f I 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 p {Numbe of7 _
Size- t. Xft . .
Gravel sire R —
PIPING = Size Ty e
Bldgo to tank
Tank to disc . box
Dist* box to ieldjAolmtz� �EEE
Openings sealed? YES O Partial
LOCATION/SEPARATI Sx
Foundation to tank. t
Foundation to absorption Xf
tAbsorption to lot linet •
Separation of pits t'
LC?C`ATION Y'aTEM ON PROPERTY (circle one)
Front - air Left side - Right side -
c C KMENT �J
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SYSTEM USE APPROVE- . .. YE NO
Hui. ding Inspector
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