1987-676 BUILDING PERMIT y
TOWN OF QUEENSBURY No. 87-676
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Richard Ha ' eck
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OWNER of property located at Arson Rd . Street, Road or Ave.
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in the Town of Queensbury, To Construct or place a Sewage Alteration r a
at the above location in accordance to application together with plot plans and ether information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance_
1. OWNER'S Address is Same
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2. CONTRACTOR or BUI LDE R'S Name x
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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)
I I Wood Frame i 1 Masonry f ) Steel f Y to
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7. 'PLANS and Specifications 0
No. 1000 gal tank, 5 ft . trench total system -2:RQ 250 ' as per plot plan
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and application ro
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8_ Proposed Use n
Sewage alteration a
$ XK 10600 PERMIT FEE PAID — THIS PERMIT EXPIRES October 8 1989
(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 yy 8th Day, of October 19 87
SIGNED BY y L C . -mac-' for the Town of Queensbury
Building and Zoning Inspector .
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APPLICATION FOR SEPTIC DISPOSAL PERMIT OCT 1%7
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BATE
LOCATION OF PROPERTY FOR INSTALLATION E 1. { X 0y.
Owner's Name: �c. ,� � Telephone: Cf„� '/20 5
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Address: _ c�
Installer's Name: Telephone:
Telephone:
Number of bedrooms (residential only) _
Total daily flow (compute @ ISO gal per bedroom) 6°
Topography: circle one Fl Roiling Steep Slope % of slope
Soil Nature: circle one San Loam Clay Other / Depth: feet
Ground Waters At what a g-- ( feet
Bedrock or Impermvious Material: hat depth? _ feet
Percolation test: circle one not requirye required / rate min. inch.
Domestic water supply: circle one* Municip Well Other
IF domestic water supply is a Wen:
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM: Septic Tank _� gal. (minimum size: 1 ,000 gal. )
TILE FIELD: Each Trench 4 �
— feet / Total system length < feaacsO
SEEPAGE PIT(S) : Number of / Size each 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 Z4 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 systems , 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 Seer a Disposal. Ordinance.
Signature of responsible person:
Date:
Town of Queensbury
Building and Code Department
Day at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOO. PLACE TO LIVE
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of
gUf4D1P1G and ZO"'NG i3EPAFI 1BOX 98
Bay and Havifand Fjeo York} 28Qi
pueensbury,
SEPTIC T]I SPOSAL_ SYSTEM INSPECTION
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LOCATION
DATE ►'C5 f — �--_
SCSL TYPE - Sand - Loa}rrn ed ?C� YES NO
percolation Teat Redo h
percolation rate p+��n/I
TYPE of SXS'TEMd� to l length
Absorption f '
Length of
ach tree
ID of t e enches
size of gr el
� er of)
SEEPAGE FIT f t.
Size- �-f t. Type
bra-Vel size size
FTPII4Ga'slag . to tan box �---r-
Tank to dirt
Trist . bo field No Partial
x t led?
ppenings s
PARATICNS ° ft-
LOCATICN/ to tank ft .
Foundatio to abaarPtion ft.
Foundati to lot line ft.
Absarpt ircle one)
Separat ors of pits
OF SYSTEM QN PRE7PER ght a de
14OMTI _ 1eft side
Front Rear
CCVtM'EI3 S
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zS�o G Qx.
Sys USE ABPRQVZp
YE ' No
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ding nap ar
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J ' BUIL1--)I *1G and ZONING TDEPARTMENT
Say and Haviland Road. R.0. 1 Sox 98
Oueensbury. New York 12801
SEPTIC DISPO L SYSTEM INSPECTION
NAME ;
A �J
LOCATION qJl
PERMIT
DATE / ! -
5a - Loam - Clayd.
SCIL TYPE iced? YES -
Percolation Test
Requ _�__.
nch
Percolation rate -
TYPE of SYSTEM: length
Abst>rPtion f ield • total
Length of each trench
Depth of trenches
Size of gravely -- - -..� -----�-~
SEEPAGE PITS-E13vmber f) _
size- ft. x
Gravel s1ze Size Type
PIP ING = ;Ez )(/ 5 /so � y
Bldg _ to tank �--ter L
Tank to dist _ box
Dist , box to field/pltYES No artia
openings sealed?
LOCATIONISEFARATICNS :
Foundation to tank ion Foundation to absorption 0 f t _
Absorption to lot line r---- ft_
Separation Ofit$ ONPROPERTY (Ci.rcle one)
�p xCATIUN r Rightside -
Front - ea - Left side
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COMMENT
SYSTEM USE }'APPROVED YES ONO
Building Inspector
O1/86 and vl
CERTIFICATE Ii
THE Ti6W VORK BOARD OF FIRE UNDERWRITERS ALISANYv IN , y - �12207
YOU ARE HEREBY REOU15STED TO
I NSPECTAND ISSUECERTIFICATES
FOR -IFOLLOWJNG ELECTRICA L BUILDING PERMIT NO.
EOUIpMENT TO aE jNSrALLE0 BY
THE UNDERSIGNED1
DATE
TEMP. It
_ COUNTY
CITY OR TOWNSHIP
VILLAGE 3 i"• ! •
STREET AND NO. OR r POLE NO.
TR
ROAD AND POLE NO.
BETWEEN WHAT TWO - BLOCK LOT
CROSS STREETS IS .y. - 1 •. '� ECYION
PREMISES L ATEDa ' BUILDING l �.
OCCUpANT'S 1 i i '� . OCCUPANCY 1 C .
NAME - _ I EL, #
------------
! {
OWNER'S NAME
AND ADDRESS OFFICE
U `L i FROM TH ECTS
EIR I
SUPPLIED r OFF
BY WORK NEW ❑ ADDITIONAL REMOVED ❑
BUILDING OLD
' 1S
IS NEW ❑
LIST BELOW ALL EQUIPMENT 1NHICH YOU INSTALLED
BRRANAN CH OFFICE USE
No,, of Fixtures 6 MOTORS HEATERS CIRCUITS ONLV
NUMBER OF OUTLETS Lamp Reow%mdM
Lau- H.P. 'q'W'G' INSPl:CTIL}N
tion Side Aftsch't Ro• Foe Fln' 4Saps
Csilinp Watl ROOM.1S S'M� pSMsnt BredcaL Na. Typs Each
Oil Y .:
side {
Sub-
bass
BSser
"n t
Yet FL
2nd Ft.
3rd Ff.
DO NOT USE THIS SPACE.
REMARKS! LI57 OTHER ELECTRICAL DEVICESNOT SET fORTH ABOVE;
equipment not above listed.
action them ss found additional
This SpPI
icatill is intended to cover the aboveIiIisled sellax la be inspected but it at time of imP beast.
you ors ,wMoeizad to melee Me inspection and adjust the fee fe GOMer the additional equipmenf. as prpvided 6y the epP TOTAL
ELECTRIC SIGN WATTS
SIZE Of FEEDER'S LAMPS
MAINS GAS TUBE SIGN
EXPOSED -TRANSFORMERS OF VA
CHARACTER CONCEALED (CAPAGTV$
OF WORK (NUMSFRI
WORX TO BE COMPLETED SIZE OF SIGN
STARTED
SERVICE OVERHEAD UNDERGROUND OF SIGN
ENTERS
BUILDING
INSPECTION REQUESTED NEsy � OLD
OSS BAS NEAR AS
AVOID DELAY BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES APPLICATION.
MUST BE FILLED IN OR APPLICATION MAY BE RETURNED SIGNATURE
PRINT NAME AND ADDRESS OF APPLICANT
NAME OF
APPLICANT
TELEPHONE #
STREET ADDRESS YIP LICENSE NO.
CODE WHEN APPLICABLE
CITY OR
POST OFFICE
46 EL (REV_ 1/86) A SEPARATE APPLICATION MUST $E FILED FOR EACH SEPARATE BUILDING
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