1987-834 BUILDING PERMIT �
TOWN OF QUEENSBURY �
No. $7-$34
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Margery Wilcox & Candace Jones r�'7
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OWNER of property located at 4 June Dr , Street, Road or Ave. 00
in the Town of Queensbury, Sewage Alteration
To Construct or place a
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. OWNE R'S Address is
Same
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2. CONTRACTOR or SUILDEA'S !Name �
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Queensbury Sewer Service n
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3. CONTRACTOR or BUILDEWS Address
RD # 1 Upper Bay Rd . p
Queensbury , N . Y . 12801
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4. ARCHITECT'S Name
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5_ ARCHITECT'S Address
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5. TYPE of Construction — (Please indicate by X)
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( I Wood Frame ( i Masonry { l Steel { k Cl
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7. PLANS and Specifications
No. Distribution Box 180 ' of leach fields
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S. Proposed Use tD
Sewage alterations a+
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10000 PERMIT FEE PAID -- THIS PERMIT EXPIRES December $ 19 $9 m
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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 p
town of Queensbury before the axpiration date.!
Dated at the Town of Queensbury this 8th Day of December tg $7
SIGNED BY fir' q� e e�2 4[ for the Town of Queensbury
B u ild l ng end Zoning I n spactor
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APPUCAT ON FOR SSEPTiG DISPOSAL PERMIT
DATErd 4D
LOCATION OF PRPPERTY FOR INSTALLATION _It
Owner's Name: �� C�. / ' i Telephone:
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Address: ____ r _ ,r� LA
Installer's Name: C `c k k4c 'e N;s 4-4, v- 1 IUJx ✓`' Telephone:
Number of bedrooms (residential only )
Total daily flow (compute (LD 150 gal per bedroom)
Topography: circle one Fla Rolling Steep Slope 'r of slope
Soul Nature: circle one: Sand Loam Clay Other / Depth: feet
Ground Water: At what depth? feet
Bedrock or Impervious Material: At what depth? _ feet
Percolation test: circle one: Vre required / rate min. inch.
Domestic water supply: circle one�unici a� i Well Other _
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption _ feet
PROPOSED SYSTEM: Septic TankZ4`-"r'-"'-' gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench S'._" feet / Total system length l �'''- ' feet
SEEPAGE PIT(S) : Number of / Size each feet by feet
Size of stone to be used # / Depth or Thickness �...G ) 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, 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 $250.00.
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: h �1
Date: u /a< �~ 7
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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