1988-768 BUILDING PERMIT
TOWN OF EENSB R QU U Y No. 88-768
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Kathy Barlow
OWNER of property located at - 9 wer Dix Avenue 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.
1. OWNER'S Address is
185 Mott Road
Gansevoort, New York 12831
2. CONTRACTOR or BUILDER'S Name Id
1
Frank Shaw 0
0
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address �o
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6. TYPE of Construction—(Please indicate by X)
H.
( )Wood Frame ( ) Masonry ( I Steel ( 1
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7. PLANS and Specifications
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No. 200 feet'tile. field
8. Proposed Use •
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$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 11 19 90
(If 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 date.)
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Dated at the Town of Queen this 11th Day of October 19 88
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SIGNED BY e%(f2L ./ for the Town of Queensbury 0
Building and Zoning Inspector
Oi[ezrw try 5
\' . DAT
11 APPLICATION FOR SEPTIC DISPOSAL"PIiRM!'I' 2Utilh & D CODES DEPT.
7 IN c)•i QLIE€:;?\ , .IOWN Of QUELIiSUUIt'
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SEp198''
BUILDING, & CODE DEPT. •
LOCATION OF PROPERTY FOR INSTALLATION qI k oc&.i v- O Ip'. A v't
Owner's Name: 1. /4. tl k, gq,c./oco - ""Telephone: 2 q2 — �'g °V
Address:. _ I '5 Moil" 6e5P 6ccyL,s-e"uc % /?/". 2'i" 'LZv.?W
Installer's Name: /-r4-1,1/e EJ' o..4.j Telephone: <"
Number of bedrooms (residential only) ``"' '' ' :, - -
Total daily-flow(compute'@ 150 gal per bedroom) "SZT " '' .
Topography: circle one:a10 Rolling Steep Slope % of slope
Soil Naturci"circle one Sand Loam ;Clay -Other / Depth: feet
Ground Water: At what depth? feet
Bedrock or Impervious Material: At what depth? feet
Percol:ition test: circle one: not required required / rate min. inch.
Domestic water supply: circle one: AZIP Well Other
IF domestic water supply is a Well:
• Separation: Watersupply from Septic absorption _ feet
PROPOSED SYSTEM:. Septic..Tank. T/ivd�.gal. . (minimum size: 1.000 gal.) .
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TILE FIELD: Each Trench (5 feet / Total system length .Z00, feet"
SEEPAGE PIT(S): Number of / Size each feet by - feet
Size of stone to be used 11 / Depth or Thickness feet
44 4 444444 4 4 4 4 4 4 4 * 4 4 * 4 * 4444444 44 4 4 4 4 4 4 * 4 4
IMPORT;A-'NT •
' ...Please...LIST NEW "EQUIPMENT TO BE INSTALLED
4 4 * 4 4 44, 4 4 4 4 44 4 4 4 4 4 * 4 * 4 4 i 4 4 4 4.4 * * i 4 4 4 4 4 4 * * *
(over).,
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Section Il j• ',''' Septic System Inspections: - • ' .
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'..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: . .
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1.): the proposed location of the system
. : 2.) ,location and distance to lot lines . •
• :. 3.),,location and distance to structures
E 4.)•:.lo,cation and distance to any water supply'
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, . 5.) ,,size and dimensions of all tanks, distribution
':'.boxes, tile fields and/or drywells
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. 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.
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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.
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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.
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1 have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbury.Sanitary Sewage Disposal Ordinance.
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Signature of responsible person: wht,)
Date:
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' • . Town of Queensbury .
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• - Building and ..CodeDepartent
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• , ' Bay at Haviland Road • . . •
• Queensbury, New York 12801 ' •
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• (518) 792-5832 •••
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- - - Jo tun o/ Queeniturt�
BUILDING and ZONING DEPARTMENT
0 Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC/ DISPOSAL
SYSTEM (INSPECTION •
NAME K ��z��ti(1�_ /
LOCAT I ON��-jAl IL- 21 -p
DATE4/5"/ PERMIT NO. �"S 75��_
f
SOIL TYPE - .Sand - Loam - Clay /
Percolation ';.est Required? YES1- NO
Percolation , to - Min/Inch
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TYPE of SYSTEM: ;r
Absorption field, total •''� •th'2
Length of each t -nch
Depth of trenches;
Size of gravel ‘ / i_—
SEEPAGE PITS{Numbel f)
Size- ft. X t.
Gravel size I t
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PIPING: J 'fA Size rj, Type
Bldg. to tank ?a
Tank to dist. box , /./L',.
Dist. box to •field/ Arlfilf
Openings sea4sealed?d? S , O •arti-1
LOCATION/SE ARATIONS: Fa c
-9-1
Foundation to tank _ e--
Foundatio to absorption ' itt.
Absorption to lot line /ft.
Separatia of pits %, ft.
LOCATIO e= SYSTEM ON.PROPERTY,(circle one)
Front 4 - Left side - Right side -
COMMEN S. \\\
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SYSTEM USE APPROVED O
Buil ing Inspector
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