1987-733 BUILDING PERMIT
TOWN OF QUEENSIBURY �
No. 87- 733 z
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Community Chapel wo
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OWNER of property located at 57 Main St . Street, Road or Ave.
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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.
f• OWNER'S Address is Same
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2. CONTRACTOR or BUILDER'S Name
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Reliable Sewer Service
3. CONTRACTOR or BUILDER'S Address d
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4. ARCHITECT'S Name
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S. ARCHITECT'S Address p
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S. TYPE of Construction — (Please indicate by X)
f ) Wood Frame i l Masonry ( ) steel ( 1
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7. PLANS and Specifications CD
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No. 1000 gal tank : seepage pits 2 each 6 ' x 8 ' per plot plan and
application . l�
8. Proposed Use r
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Sewage Alteration
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$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES October 29 99 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 29th -Day of October 19 87
SIGNED BY _ f F" 2a �• X - ""� l for the Town of Queensbury
Building and Zoning Inspector _
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APPLICAMON FOR SFAnlw"C DISPOSAL PERMIT OCT 2 71%7
' ] BUILDING & COD DEPT.
DATE /' fr ryfr ' vVyl [�,
LOCATION OF PROPERTY FOR INSTALLATION /
Owner's Name E4 Telephone:
Address: r�
Installer's Name: / * J' .� - -! _ Telephone: 2'd7.2 �{ �) J
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) � �►�i
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Topography: circle one: let Rolling Steep Slope Yo of slope _
Soil Nature: circle one: and Loam 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 j rate min. inch.
Domestic water supply: circle one: Municipal Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption _ feet
PROPOSED SYSTEM : Septic Tank/ po V gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S) : Number of �_ j Size each feet by , feet
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Size of stone to be used # / Depth or Thickness feet
IMPORTANT
...Please...LIST NEW EQUIPMENT TO BE INSTALLED
(over)
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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, 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.o0.
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 pe7rson:
Date:
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTLED 1763 . . HOME OF NATURAL BEAUTY . . A GOOD- PLACE TO LIVE
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/ BUILDING and ZONING DEPARTMENT
l �l} / Bay and Haviland Road, R.D. 1 Sox 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
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LOCATION
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DATE A ^� PERMIT NfJ.J ,.4
SOIL TYPE - Sand - Laam - 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 pj:TS4NUHCb ` of ) _
Size- ft. X 4 ft.
Gravel size
PIPING : Size Type
Bldgm to tank
Tank to dirt _ box
Dist . box to field/
openings sealed? YES N Pa ial
LOCATION/SEPARATI
Foundation to tank ft.
Foundation to absorption ft .
Absorption to lot line ftw
separation of pits ft.
LOC,ATZ SYSTEM ON PROPERTY (circle one)
Front - Left Side - Right side -
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SYSTEM USE APPROVED OYES NO
Build ng InsPector
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