1989-224 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 89-224 Q
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Earle A Lorraine Davis
OWNER of property located at ef!r*=MS Roa Street, Road or Ave. G
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.
1 . OWNER'S Address is C
Star Route
Glens Falls ,N . Y . 12801
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2- CONTRACTOR or B U I LDE R'S Name
Walter Stevenson r
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3, CONTRACTOR or BUILDER'S Address C
a
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4. ARCHITECT'S Name
5. ARCHITECT'S Address
}d
7777iii
6, TYPE of Construction — (Please indicate by XI
l 1 Wood Frame i t Masonry I ) Steel I l p
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7, PLANS and Specifications r
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No. 1000 gal . tanks 1 9 ' x9 ' existing seepage pit as per plot plan and Si
application to
S, Proposed Use 7
t
Sewage Alteration
PERMIT FEE PAID — THIS PERMIT EXPIRES April 27 191
(if a longer period is required an application for an extension must be made to the Bu➢iding and Zoning inspector of the
town of Queensbury before the expiration date)
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Dated at the Town of Queensbury this Day of A ri l 19 8'9
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SIGNED BY for the Town of Queensbury r
Buildingand Zani specter
TOWN OF QUEENSBURY
Z I -'TC7,�n- Ok UEENSBURY
APPLICATION FOR FEE EIVED
> SEPTIC DISPOSAL PERMIT APR
/� {y r BLDG. & CODE DEPT,
DATE / / / 5 /
LOCATION OF PROPERTY FOR INSTALLATION CZ- 40-
Owner's Name:, 10kAr w ,-,r .c- r' (�//.STelephone:
Address: /
Installer`s Name: Telephone: 4 `
Number of bedrooms (residential only) ---
Total daily flow {compute (d 150 gal per bedroom) on! C>
Topography: Circle one: ~Flat Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand Loa , Clay Other /Depth : Feet
Ground 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 supply : circle one: Municipal 'Nell Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEi13: Septic Tank OOTZI gal. ( minimum size: 1 , 000 gal.)
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SEEPAGE PIT(S): Number of / / Size each feet by �fee4� X �.c7 #�rt"& ..
Size of stone to be used # /Depth or Thickness feet
I have read the regulation on the reverse side of this sheet and agree to abide by these
and all requirements of the Town of Queensbury Sanitary Sewa a Disposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON :
DATE : jz,
OVER
Stic 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
S . ) size and dimensions of all tanks , distribution boxes ,
rile fields and /or drywells
B . No system shall be covered before inspection and approval by the
Building 1115pector . Failure to comply with this requirement may
1` vsult in the uncovarin�; of the system by the installer and a fine
of up to y 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 installa-
tion , alteration or repair of an approved system , a new proposal must
f, e submitted to the Quuunsbury Building Department before further
Construction .
Town of Queensbury
BUILDTNC and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
. Jvta►e o/ QueeJJury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 96
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION
DATE a/ PERMIT NO .
SOIL TYPE - Sand Loam - Clay T—�±f
percolation Test Required? YES -,4O
Percolation rate - Min/Inch -- -
TYPE of SYSTEM :
Absorpti n field , total le th
Length o each trench
Depth of trenches --
Size of g avel- �.-... --
SEEPAGE PINS ENumbE'r o
Size- fkt. X
Gravel size
'P IPING : Size F
Bldg . to tan --- y-- rr
Tank. to list . �?rt
Dist, box to f ti
d/p S Paral
openings seale� NC)
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LOCATION/SEPPA TINS : r °5, fto
Foundation t tank `. ft .
Foundation o absorption ft.
Absorption to lot lire, ft.
Separatio of pits
LOCATION SYSTEM ON PROPERTY (circle one)
Front - ar - Left sid6 - Right side
CC 4KENTS /
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SYSTEM USE APPROVED YES N
Bui ding inspector
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