1987-789 BUILDING PERMIT �
TOWN OF QUEENSBURY No 87- 789 �
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Bennett Patrick ,
1
OWNER of property located at 11 Owen Ave . Street, Road or Ave. N
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 Oueensbury Building and Zoning Ordinance_
1 . OWNER'S ,Address is
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2. CONTRACTOR or BUILDERS Name
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Gary Moon .�
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3. CONTRACTOR or BUILDER'S Address ry'
4. ARCHITECT'S Name
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S. ARCHITECT'S Address p�
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6. TYPE of Construction — (please indicate by XI C
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l ) Wood Frame ( } Masonry { 1 Steel { }
7. PLANS and Specifications
No. Relocate sanitary line that had collapsed , as per plot plan and
application .
S. Proposed Use p'
Sewage Alteration ro
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$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES November 25 19 89 C1r
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(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queenabury before the expiration date j
Dated at the Town of Queensbury thiss225th Day of November lg 87
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SIGNED BY J +' / ez el for the Townof Queensbury
B /�.,uilding and Zoning I nspector - C:�. , —
APPLICATION FOR SEPTIC DISPOSAL PERMIT ��J
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44 , ' NOV 19198?
DATE u �..� ,� ! .� ?
LOCATION OF PROPERTY FOR INSTALLATION �J&;—^Woo .
Owner's Name: �f� ��- � - Telephone: • -
Address* / / O G./�*✓ / v R_� C� .�+�' —/�-- 'G+/'/s r1' • / �`� t'
Installer's Name: 6 fxl .e Telephone:
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) ts
Topagraphq: circle one: Flat Rollin; ' teep Slope % of slope
Soil Nature: circle one: Sand L m oa Clay Other / Depth: feet
Ground. Water: At what depth? t feet
Bedrock or Impervious Material: At what depth? _ ^-`XX feet
Percolation test: circle o e: not required equired / rate min. inch.
Domestic water, supply: 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 / 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 lI 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 $250.00.
C. An approved copy of the plot plan shall be available an 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 aU requirements
of the Town of Queensbury Sanitary Sewage Disposal Ordinance_
Signature /of responsible person:
Date:
Town of Queensbury
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
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