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1989-237 BUILDING PERMIT TOWN OF QUEENSBURY No. 9_ i WARREN COUNTY, NEW YORK PERMISSION is hereby granted to Paul Smith ,T OWNER of property located at "7\D Dixon Road Street, Road or Ave. 1n 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 Queenshury+ Building and Zoning Ordinance. 1 . OWNER'S Address is Sane �-I 2. CONTRACTOR or BUILDER 'S Name r �O Sanitary Sewer ou c J 3. CONTRACTOR or BUILDER 'S Address 4. ARCHITECT'S Name V Ch 6_ ARCHITECT'S Address p x 0 7�p 6. TYPE of Construction — (Please indicate by x) CL S i Wood Frame ( } Masonry I I Steel I I 7. PLANS and Specifications No. 1000 gal , tank w/ 2 4 ' x 6 ' 'seepage pits for 'washer only as per plc plan and application . S. Proposed Use Sewage Alteration + x tes ro $ 25 . 00 PERMIT FEE PAID — THIS. PERMIT EXPIRES April 19 91 �.i. (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the eD town of Queensbury before the expiration date.) W r+ J Dated at the Town of Queensbury this 28th iDay of April _ _19 89 a SIGNED BY for the Town of Queensbury Building and Zoning I nspector TOWN OF QUEENSBURY JrG( _ A Iti APPLICATION FOR TOWN OF QUEE NSBURY RECEIVSEPTIC DISPOSAL PERMIT APR 2 ,11z {?t7 BLDG. &. CODE DEPT, BATE LOCATION OF PROPERTY FOR INSTALLATION Owner's Name: - p M ItT 1-[- Telephoner r-� 7t ( �- �,' Z r Address:,1 � 1k rya � u � fir. �� � !k` J1 `I Installer's Name: AIv Telephone: ` j - /?-;2 ,,57 Number of bedrooms (residential only) VY � f1 Total daily flow (compute (d 150 gal per bedroom) Topography: Circle one: Flat Rolling Steep Slope ©b of Slope Soil Nature: Circle one: an Loam Clay Other /Depth : Feet Ground Water : At what depth ? Feet Bedrock or Impervious lllaterial: At what depth ? Feet Percolation test: Circle one<:n:o:t required required rate min. inch. Domestic water supply: circle one: 'iunici a Well Other If domestic water supply is a well: Separation: Water supply from septic absorption feet PROPOSED SYSTEi%I : Septic Tank f + l] gal. ( minimum size : 1 . 000 gal.) TILE FIELD: Each Trench r feet/Total system length feet SEEPAGE PIT(S): Number of Z- / Size each feet by feet Size of stone to be used #,3 /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 QueensbiI Sanitary Sew Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON : DATE : 2 6 OVER 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 CO the Building Department at least 24 hours before start of construction and shall include a plot plan showing : 1 . ) tiie proposed location of the system 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 L . Nu System shall be covered before inspection and approval by the i:uilding Inspuctor . Failure to comply with this requirement may FvSult in the uncoverinb of the system by the installer and a fine of up to $ 250 . 00 . C . An approved cagy 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 proposril must k,c submitted to the Queensbury Building Department before further colz :atruction . Town of Queensbury BUILDING and CODES DEPARTMENT liay and Haviland Roads Queensbury , New York 12804 kur�i:ark5 : , BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. U. 1 Sax 98 Queensbury, New York 12801 SEPTIC ISPO L SYSTEM riI NAMSPECTION r LOCATION DATE fQ PERMIT NO . l7 1�' + •�" 1 gOI TYPE - Sand -- Loam - Clay Perc at Test Required? YES - NO Percol tion rate - Min/Inch - TYPE of YSTEM: Absorpti.o fieldo total length Length of ach trench Depth of t nches�� Size of gra of } SEEPAGE P I um➢a Size- to X t. Gravel Si a Sit TyF' � pIPING : �- Bldg . to tank Tank to dirt_ box Dist . box to field partial Openings sealed'? S NO LOCATION/SEPARATIOI?�S : �zoofto Foundation to tank *If Foundation to absorption t_ Absorption to lat line ft. Separation of p.,Its ON OF SYSTEM aN PROPS TY (circle one) ront - Rear ~. Left side - ht side - ENTSe / SYSTEM USE APPROVED YES O Building Inspector 01/86 and v1 Y J3u � . D, Aj leo , I :i TOWS t f W tr i f ox A �— IGC�U C t i 3 t5 1Uorrn a jEf'T1C TNK �JltYuIEtCS I Sl4�NC `{�26�Sq