1987-719 BUILDING PERMIT y
TOWN OF QUEENSBURY No. 87-719 �
WARREN COUNTY, NEW YORK
PERMISSIO hereby grated to Tom. Delcourt
/� ��j 00
OWNER of property located at
`z ' + tOfr-Bay Rd . Street, Road or Ave.
I
Alteration a
in the Town of Queensbury, To Construct or place a Sewage �
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.
1 . OWNER'S Address is Same.
H
0
S
2. CONTRACTOR or BUI LDEWS Name
r-�
n
Breton Excavating Q
rt
3. CONTRACTOR or BUILDER'S Address
4_ ARCHITECT'S Name
•r
0
ON
W
N
5. ARCHITECT'S #ddress
POE
6_ TYPE of Construction — (Please indicate by X)
{ 1 Wood Frame i ) masonry l l Steel f !
7_ PLANS and Specifications tin
M
E
No. Existing tank adding Dist . Box 2 4 x 8 seepage pits per plat plan m
and application . y
8_ Proposed Use eot
Sewage alteration
a�
e-r
w
0
$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES October 27 19 89
Uf a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of QueensburV before the expiration date)
Dated at the Town of O.ueensbury this 27th Day of October 19 87
SIGNED BY f zd— for the Town of 0ueensbury
Building and Zoning I nspector
TOWN WN OF
}
too 0wonor
1 N W-, T F I
jo L OCT 211987
APPLICATION FOR SEPTIC DISPOSAL. PERMIT OF
4
F ' 1 ! �? `i ^JCS rx
DATE / C7 cZ 1 /
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name* -7�0s 2>d� I C.o0ram- 7-- Telephone:
Address: f If> Co l3,a 'D _ cf ,J ,s
Installer's Name: Qfr r i a . drxCr Y4 T.a . ' ,�� G Telephone:
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) o
Topography: circle one: iav Rolling Steep Slope °f6 of slope
Soil Nature: circle one: San Loam Clair Other / Depth: T feet
Gwound Water: At what depth? feet
Bedrock or Impervious Material- At what depth? _ feet
Percolation test: circle one: not required required / rate min. inch.
Domestic water sutpplg: circle one: Municipal ell Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption _ feet
PROPOSED SYSTEM: Septic Tank . gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S) : Number of --;X,.. f Size each ^ feet by e feet
Size of stone to be used # / Depth or Thickness C;2- feet f ' :F f* C, o
I M P O R T A N T
...P'lease...LJST NEW EQUIPMENT TO BE INSTAL.L.ED
.fit OVFV & Oca�T: F3C) >c
(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:
l ,) the proposed ,location of the system
Z.) 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 $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system , a new proposal must be submitted
to the Queensbury Building Department before further construction.
I have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person:
Bate: l eq
Town of Queensbury
Building and. Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . A GOOD PLACE TO LIVE
�. 0. "
�/"/ �eeeen .l � eere�
90 fVnOd I 7
0f1NG DEPARTMENT BUf13Ga
ay and Haviland e o
x 9$
pueensburYtN York12801
SEPTIC Di �€'
C3SRtir SYSTEM IAfS PECT I ON
1E
LOCAT
NOW
M MI
I PEW,
DATE /
Loam - Clay -
SCIL TYPE Sand a YES - No
ME
Percolation Test gequired
Percolation rate - Z+Sirt/Inch
TYPE of SYSTEM total lengtYr
Absorption f ield ME I ME ME
Length of each trench
Depth of trenches size of 9raS'e3 of) ���
SBrppvGE p f to T
ft.
Gravel size SizeXP
nldc3 . to tank
Tank to list . box U '
Dist. box to f iel Np Partial
s sealed? Y
openinc3
I,pCpiTlO'NI587rARAT'IONSs. ft.
Foundation to tank t.
Foundation to absorption t'
ounrp'tion, to lot lineyi'bso e ft•
Separation of pits PROPERTY (circ le one)
�;,LTXoi3 Cr SYSTEM side - Right
Front - Rear Left s
SYSTEM USE APPROVE."' 'ESA
8
1 inq Inspector
41I86 and vl
T ( �low►� 01 Qeteeri
=�
BUILDING and ZONINGDEPARTMENT
�( Say and Haviland Road, R-0 - 1 Sox 96
oueensbury, New York 12801
'C
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME I�i r th -
LOCATION +
/
DATE I4 I PERMIT NO .
SOIL TYPE - San - Loarn - Clay
Percolation est Required? YES NO
Percolation rate -- Min/Inch
TYPE of SYSTEM: �tli
Absorption field , tota _�
Length of each ch11
Depth of ches� /' �
Siz gravel
S PAGE PjITS�rt3uml�e of)
Size- r'{ ft. X �ft - �
Gravel size
PIPING : Aoe,��77 TypeBldg . to tank.Tank to list . boxDist . box to fielcl/pit
YEO Paxtial
Openings sealed?
LOCATION/SEPARATIONS : ft.
Foundation to tank
Foundation to absorption ft
Absorption t ft .o lot line ft .
Separation of pits
LOCATION ON EM ON PROPERTY
(aircle one)
Front - e6 „ Deft side - Right side -
COMMEI3 I' .'"
j/ (� }9 1
AI
irk
AI
.lam
SYSTEM USE APPROVED YES NO
Buil ing Inspector
01/86 and vl
r
A
,
MAP
of tends of
IWA gx Asli m io�4 KAR11r . As"
rown of Oueenshury , Warmn County , Mew rbr*
NOV 4M. 1985
G�
Of '�'a, $ WAYS F? YM G�
LICEII LAND S►1hq% cvt>q
<3If_C .tS FALLS a WF_'VERPOWN. N.Y
p . r�
~r Le Ve nd
I PF- Iron Pipe Found ,
IRF - Iron Rod Found .
Agj5,A = AC. 1 `', IRS - .Iron Rork 'Set .
1 .06
0
l
ti U
Ch
fiddf c� �-
o csz
" Deed Referent
Friedarl the W + 5 5 '
Ricriards Li Xg
y Karin M . AshCIS
f "}
t-MA 653 -- 3571 dt c4./9,/83
f f :,may 01 Lo.
t
•1� � "� � Yew yF :'Y$ Y
L
— o 4725�.ao-"w --�" Irs�x.es' y r _ 5_ 44 4,dr,OF '7 - W lQ91E
BA Y ROAD
-;r In Glor-+s F-o/fa = 7 N'
/VV = 7