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1987-632 BUILDING PERMIT � TOWN OF QUEENSBURY No 87-632 WARREN COUNTY, NEW YORK o William ehandler N PERMISSION is hereby granted to N ( `� ne . 1 OWNER of property located at Piwood Rd Street, Road or Ave. 0 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. r• 1 . OWNER'S Address is Pinewood Road w Queensbury , N . Y . 12801 n 2. CONTRACTOR or BUILDER'S Name ¢' G. Sanitary Sewerrb ry 3- CONTRACTOR or BUILDEWS Address 4. ARCHITECT'S Name �a F�• [o 0 0 6, ARCHITECT'S Address Q" a sd 6. TYPE of Construction — (Please indicate by X) ( ) Wood Frame ( ) Masonry ( ) Steel ( 1 7. PLANS and Specifications No 1000 gal . septic tanks distribution box and 1 - 6 ' x 8 ' dry wells , per plot plan and application . Cn m a. Proposed Use le Sewage alteration to one family dwelling w ro N r* m $ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES Sept • 21 : ' 79 89 (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the r• town of Queensbury before the expiration date.) Dated at the Town of Queensbury this 21st Day of Sept 79 87 SIGNED BY ,rCY .- for the Town of Queensbury Building and Zoning Inspector TOWr4 OF QUEE iSC)i APPLIGATI©N FOR SEPTIC DISPOSAL PERMIT [8 1r i �f E 1W r � /�- SEP 11 W7 Ok SU,I.L�DING F3c �.:OUE DEPT. DATE __ / f1'C�r /0400 LOCATION OF PROPERTY FOR INSTALLATION Owner's Name: Address: Installer's Name. Telephone. J X `z Number of bedrooms (residential only) Total daily flow (compute @ 150 gal per bedroom) Topography. circle one Flat Rolling Steep Slope % of slope Soil Nature: circle one: and Loam Clay Other / Depth: _ €eet Ground Waters At what depth? feet Bedrock or Impervious Material: At what depth? _""` feet Percolation test: circle one not required x equired / rate min. inch. Domestic water supply: circle on Municipal Well Other IF domestic water supply is a Weil: Separation: Watersupply from Septic absorption _ feet PROPOSED SYSTEM: Septic Tank 'd 0 'C] gal. (minimum size: 1 ,000 ,gal.) TILE FIELD: Each Trench — feet / Total system length feet SEEPAGE PIT(S) : Number of / Size each feet by -4L. feet Size of stone to be used # Depth or Thickness feet IMPORTANT ...Please...LIST NEW EQUIPMENT TO BE INSTALLED (over) i Y Section 1I 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, the 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 a to abide by tbLim and all requirements of the Town of Queembury Sanit Sewag Disposal Ordinance Signature of re sponsible person; Date; Town of Queensbur-y 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 LIVE { _7otv0,I v o ueens ttr gUtLpING and ZONING DEPARTMENT Bay and Haviland Road, R. Q. 1 Box 98 Queensbury. New York 12801 SEPTIC DISPO SYSTEM I SPECTI N NAME c+r dA a LOCATION i7 -e Ifj' d PERMIT NO . IP :7 ' DAT£ SOIL TYPE - Sand - Loam - Cay l? ercvlat -on Test. pequired? l NO YES - percolation rate - Min/''Inch - TYPE of SYS'TF..M= fatal length Absorption f ield e Length of each trench I)epth of trenches Size of graver_ SEEPAGE ,PrITS4jNumber of ) Size- ft. X 4:2eLf4t i GraVel size Sa�ze -, Type PIPING : fi °y � v1 Bldg , to tank 'J-"�'-; eze Tank to di st . box L - Dist_ "box to fielrIyES NO partial Openings sealed . J� LOCAT T ON/SEpARAT I ON S : to Foundation to tank Foundation to absorPt:e ft. Lion to lot line AbsoxP f pits f t` Separat" pROPE le . one) LOC'ATI F ;YSTEM si Front kea{rd - Left side - r CC14MEN ° SYSTEM USE APPROVED YES r r Building Inspector O1/$6 and V1 s 1 I G i t I i L i4L t i