1988-289 BUILDING PERMIT
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TOWN OF QUEENSBURY
No. 88-289 `u
WARREN COUNTY, NEW YORK o
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PERMISSION is hereby granted to Mace sa mI
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OWNER of property located at Knolls Road South Street, Road or Ave. o
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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.
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1. OWNER'S Address is a
Same
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Q.)2. CONTRACTOR or BUILDER'S Name
Hometown Sewer
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3. CONTRACTOR or BUILDER'S Address
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Rte. 28 - Glen Rd. m
Warrensburg, N.Y. 12885
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) iq
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( )Wood Frame ( ) Masonry ( )Steel ( )
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7. PLANS and Specifications Ali
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No-Existing 1000 gal. tank and 400' tile field as per plot plan o
and application
8. Proposed Use
Sewage Alteration
$ 10.00 PERMIT FEE PAID—THIS PERMIT EXPIRES May 1 199n
(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 Queensbur this 26th Day off May 19 88
SIGNED BY a.771 A7 � L/ for the Town of Queensbury
Building and Zoning Inspector
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O APPLICATION FOR SEPTIC DISPOSAL PERMIT
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DATE 5-' / MAY 2 5 128
BUILDING & CODE DEPT.
LOCATION OF PROPERTY FOR INSTALLATION e9fi' r //fvLP.Sdet`�
Owner's Name: a6e (�„„44,0/-cam Telephone:
Address: _9rM /7S t4
Installer's Name: 1-7/0�, e foaj Telephone: c 5 - cg 5- 3
Number, of bedrooms (residential only) 3
Total daily flow (compute @ 150 gal per bedroom) Y$'O
Topography: circle one: ieRollig Steep Slope % of slope
Soil Nature: circle one: Sand 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 6- min. inch.
Domestic water supply: circle one: Municipal /, Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption _/'po feet
PROPOSED SYSTEM: Septic Tankjc,';0.1„ gal. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench 5O feet / Total system length `Y•O 0 feet
SEEPAGE PIT(S): Number of / Size each feet 1 y feet
Size of stone to be used # _ Q / 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.
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 Sewage Disposal Ordinance.
----Signature-of responsible person: AL ,�� -- — --
Date: ,.?5
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
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SET Or I_ 7Y f? TO L
gown of Queen 3hu9,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME ,( /1-C4- Co/n 60 )2/4-
LOCATION EU...5 109_`SurtA-
DATE 6// / PERMIT NO. g' ,R
SOIL TYPE - Sand - itt4 - CO-
Percolation Test Required? YES - NO
Percolation rate - Min/Inch a' -zg
TYPE of SYSTEM: f
Absorption field, total length ''DO
Length of each tre ch
Depth of trenches ' "/'-- 3o /A,
Size of gravel ,
SEEPAGE PITS uMber of) :_,-
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Size- _.......-ft. X _
GraY<er ize
PIPING: S' e Type
Bldg. to tank --,
Tank to dist. box </ " ` ,'r 7l /-70
Dist. box to field/.1 ` `L `,-
Openings sealed? 400 NO Partial
LOCATION/SEPARATIO S:
Foundation to tan ' 2, 7ft.
Foundation to absorption .sft. r.
Absorption to lo, line ,/.. ft.
Separation of pits iii, ' ,ft.
L• ON OF SYS'T u •k. PROPERT (c'rcle one)
+ runt Rear - Left: side - Righ side -
COMMENTS: /
SYSTEM USE APPROVED 411' NO
Building Inspector
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