1989-120 BUILDING PERMIT
TOWN OF +QUEENSBURY No. 89 -120
WARREN COUNTY, NEW YQRK p
PERMISSION is hereby granted to Elijah Burt �
Dixon Road Street, Road or Ave. a+`
OWNER of property located at I.-"
in the Town of Queensbury, To Construct or place a SCWaCFe AIIA
lens and other information hereto filed and
at the above location in accordance to application together with plot p
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1 . OWNER'S Address is Same I33
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2. CONTRACTOR or BUILDER 'S Name M
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Sanitary Siewer H
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DannXel Drellos
3. CONTRACTOR or BUILDER'S Address
p Q . Box 224
Glens FAlls , New York 12801
4. ARCHITECT'S Name tv
C7
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5, ARCHITECT'S Address 7'
B. TYPE of Construction — (please indicate by XI
1 ) Wood Frame ( ] Masonry { ) Steel I )
7- PLANS and Specifications
3000 gal _ existing tank. , 200 ' of file field as �aex plot
No. K
plan and application _ t
8. proposed Use j
Sewage Alteration i
$ 25 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES March 30
l9 91
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Quaensbury before the expiration date.)
Dated at the Town of Queensbury+ thl
30Ch Day of March 19 89
for the Town of Queensbury
SIGNED BY
Building and ZonMny 1 nspecter
N OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT 1 RECEIVED
4 MAR 3 0 1989
DATE 3 3 BLDG. 8. CODE DEPT.
LOCATION OF PROPERTY FOR INSTALLATION 40
Owner's Name: / C � /� g � cJfL 1 __- Telephone:
Address: _ / {�D� ! Y
Installer's Name. _} ,A04,> a A +CZV___ u Telephone: 9 .2 - 71 6 7
Number of bedrooms (residential only) _
Total daily flow (compute @ 150 ,gal per bedroom)
Topography: circle one: lat Rolling, Steep Slope % of slope
Soil Nature: circle one: Sand Loam Clay Other / Depth: feet
Ceround Water: At what depth? feet
Bedrock or Impervious Material: At what depth? _ feet
Percolation testa circle one t required_, equired l rate min. inch.
Domestic water supply: circle one: 4urucipal Well Other-
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet
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66e e S7`or. jC P
PROPOSED SYSTEM: Septic Tank 10U0 gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length J=ZQ.O feet
SEEPAGE PIT(S) : Number of "'' / Size each - feet by - " feet
Size of stone to be used # / Depth or Thickness feet
IK4PORTANT
...Please...LIST NEW EQUIPMENT TC? 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, 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 Sanit age Disposal Ordinance,
Signature of responsible person:
Data.
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SE iTLEO 1763 _ HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE
. BUILDING and ZONING DEPARTMENT
Bay and Naviland Road, R.D . i Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION
PERMIT NO.DATE A&I
_
SOIL TYPE - Sand - Loam - Clay
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYST y Z�
Absorption fi d , total len th_
Length of each trench
Depth of trenc s
Size of gravel
SEEPAGE PITS ex of) _ ;
Size- ft. X ft . /
Gravel size ize GType
PIPING :
Bldg . to tank
Tank to dist . box
Dist . box to field/
0 mIngs sealed? S NOartial
LOCATION/SEPARAT
Foundation to t k f t .
Foundation to sorpt n ft.
Absorption t.o t line
ft.
Separation of its pERTY (cirCle one)
LOCATION TENT ON P
Front - ea Left side - Right side -
i
CCI.M .
,1
SYSTEM USE APPRCYV'ED NO
Buil ng Inspector
01/86 and vl
SANITARY SEWER SERVICE
Division of G. P. Drellos, Inc.
53 FOURTH STREET GLENS FALLS, N . Y. 12801
TELEP•y�HONE 792-7257
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