1987-890 BUILDING PERMIT �
TOWN OF QUEENSBURY z
No. 87-890 0
�J WARREN COUNTY, NEW YORRK
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Ann Gray
PERMISSION is hereby granted to
OWNER of property located at 14 Centenial Dr , Street, Road or Ave.
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. y
1. OWNER'S Address is
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2. CONTRACTOR or BUILDER 'S Name Condon ' s Septic
3. CONTRACTOR or BUILDER'S Address 121 Grant Ave . �
Glens Falls , N . Y . ro
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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C. TYPE of Construction — (Please indicate by X)
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{ ) Wood Frame ( ) Masonry [ ) Steel [ 1
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7_ PLANS and Specifications "*
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No, 1000 Gal Existing tank, 50 ft, 200 feet total) as per plot plan and o
application .
a. Proposed Use
Sewage Alteration
$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES December 28 19 89
(1f 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 dare_)
Dated at the Town of Queensbury this 28th Day of December 19 87
SIGNED BY r the Town of Queensbury
Building and Zoning Inspector
( / APPLICATION FOR SEPTIC DISPOSAL PERMIT l DEC 2 81987
CODE
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DATE /
LOCATION OF PROPERTY FOR
/I ALLATION
Owner's Name: 'sy"f} Telephone:
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Address: ,0jP7/ -( F IV / �I LZ ��
Installer's Name: t �7 e
Q � -,�c G. Telephone:
Number of bedrooms (residential only) _ 7 _
Total daily flaw (compute @ 150 gal per bedroom)
Topography: circle one: lat Rolling Steep Slope S of slope
Soil Nature: circle one: and Loam Clay* Other / Depth: T feet
Ground Water: At what depth? e feet
Bedrock or Impervious Material: At what depth? _ Q feet
Percolation test: circle one: not required required / rate min. inch.
Domestic water supply: circle one: unicipal Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption _ feet
PROPOSED SYSTEM: Septic Tank f ��� �=` � ( 5tltu�p gal. (minim 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 # 2 - / Depth or Thickness feet
IMPORTANT
...Please...LIST NEW EOUIPMENT 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
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
Be 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 $Z54.O0.
Co 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.
1 have read the regulations above and agree to abide by these and all requiretnents
of the Town of Queensbury Sanitary Sewage 13iisposal C*xl nance.
Signature of responsible person: ,
Date: " 7/
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 1Z801
(518) 742-583Z
SETTLED 1763 . . HOME OF NATURAL BEAUTY . . A C,OOD, PLACE TO LIVE
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