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1987-668 BUILDING PERMIT y TOWN OF QUEENSBURY No. 87-668 � i WARREN COUNTY, NEW YORK o Ralph Edgerly ' PERMISSION is hereby grant: to +may Co OWNER of property located at " Bay Rd . Street, Road or Ave. I w 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. t . OWNER'S Address is 6 Blencxr Ave . Hudson Falls , n . Y . 12839 a� 2. CONTRACTOR or BUILDER'S Name Sandy Hill Septic m K �c 3. CONTRACTOR or BUILDER'S Address 4. ARCHITECT'S Name tad W Gl. S. ARCHITECT'S Address 6- TYPE of Construction — (Please indicate by X) { ) Wood Frame I } Masonry ( } steel ( I to m 7. PLANS and Specifications a' OQ 1000 gal tank , seepage pit 1 6 ' x 8 ' per plot plan and application . ° No. h' r-t m B. Proposed use Sewage alteration m 0 $ 10 . 00 PERMIT FEE PAID - THIS PERMIT EXPIRES Oct . 7 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 �7th Day of Oct . 19 87 SIGNED BY 7'" '' / �--4e"eZ�' for the Town of Queensbury Building and Toning Inspector •�'�.rG'� TOWN OF QUEGi�iSrj r APPLICATION FOR SEPTIC DISPOSAL PERMIT OCT 1987 BUILDING £ic CODE CoEPT. DATE 197 pp �jyr f a LOCATION OF PROPERTY FOR INSTALLATION Z?aev Rol e910 Ir',< -- Owner's Name: Telephone: � ? 7 ' go;; T 49 rips U � Address: loom Jv% Q 57 Installer's Name: � [�' +r/'l� - f ;? .. �( L Telephone: 7Cff7 . 1 Number of bedrooms (residential only) Total daily flow (compute @ 150 gal per bedroom) 1 !o Topography; circle one: Flat Rolling Steep Slope % of slope Soil Nature: circle on C. Sand Loam Clay Other / Depth: feet Ground Waters At what depth? feet Baedrock. or Impexrvious Material: At what depth? . feet Percolation test: circle one: not required required { rate min. inch. Domestic water supply: circle one: Municipal el Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorption /c'i' d f feet PROPOSED SYSTEM: Septic Tank /49© 6 _ gal. (minimum size: 1 ,000 gal.) TILE FIELD: Each Trench feet / Total system length feet rxk SEEPAGE PIT(S) : Number of / Size each feet by y feet Sizes of stone to be used # { Depth or Thickness 4Z feet IMPORTANT ...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 $250.00M 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 Qrdinance. Signature of responsible person: Date: Q/Zf Ife ""-•- Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLES? 1763 . . HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE BUILDING and ZONING DEPARTMENT Bay and Havifand Road, R. O. 1 Box 98 Queensbury, New York 12801 SEP7IC DISPQSAL SYSTEM IPKPECTION NAME LOCAT I ON DATE _ (' / Q PERMIT SOIL TYPE - Sand - Loam - Clay - drrl�yC. 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 off) "^ Size- X ft . #- Gravel + PIPING . Size Type Bldg . to tank Tank to dirt . box Dist . box to field/pit Openings sealed? YES NO Partial LOCATTQN/SEPARATIONS : Foundation to tank ft. Foundation to absorption ft . Absorption to lot line ft. Separation of pits ft, LOCATION OF SYSTEM ON PROPERTY (circle one) Front - Rear - Left side - Right side - CC r4MENTS a � f/ fi7 S t r(A ` t e�71j�,1 7 SYSTEM USE APPROVED YES NO Buil i nspector 01/86 and ul �vwr� ©� �ure►a .f �urr� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 C)ueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCATION DATE NV / PERMIT NO.� � SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - No Percolation rate - Min/inch TYPE of SYSTEM; Absorption fieldr total length Length of each trench Depth of thes Size of g vencl SEEPAGE TS{Nur�of) Size- ft. X ft � Gravel size F —~ PIPING . Size p� Bldg . to tank / �L/ �-- Tank to list_ box ~--�'— a Distw box to field/ Openings sealed? YES NO Partial LOCATION/SEPARATIONS , Foundation to tank ft. Foundation to absorption ft . Absorption to lot line Separation of pits t. LOCATSO STEM OI3 PROPERTY (circle one) Front Rear Left side - Right side - C NT . SYSTEM! USE APPROVED YE Building inspector 01/86 and vl 4914 �? 411 je 5dgPeaI Ray of