1988-801 BUILDING PERMIT
TOWN OF QUEENSBURY No. 88_801
(a_qC) .4\Lk yRREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Wayne Pelak
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OWNER of property located at 20 Dorset Place Street, Road or Ave.
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in the Town of Queensbury,To Construct or place a Sewage Alteration w
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
Same
2. CONTRACTOR or BUILDER'S Name
Condons Septic Tank & Drain Service
3. CONTRACTOR or BUILDER'S Address ro
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17 Grant Avenue
Glens Falls,New York 12801
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) tv
( )Wood Frame ( ) Masonry ( )Steel ( ) t7
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7. PLANS and Specifications - 0
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No. 1000 gal tank existing, 1 6x8 seepage pit, as per plot plan, w
and application. C)
8. Proposed Use
Sewage Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 12 19 90
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of them
town of Queensbury before the expiration date.)
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Dated at the Town of Queensbury this th Day of - October • 19 88
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SIGNED BY .f01 `�,J for the Town of Queensbury
Building and Zon n Inspector rt
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T...1 APPIt •
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���� APPLICATION FOR SEPTIC DISPOSAL PERMIT
MI ONI 0 DLIIU COD DEPr.
g2 - -ZY TOWN OF QUEENSOUIIY
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DATE /I'1/ :
LOCATION OF PROPERTY FOR INSTALLATION c2e4-� .
Owner's Name: IL)A('jai F F /4 Pc Telephone: 7? 3 h
Address: a( )o se
Installer's Name: 5 Telephone: 9 9g-- g-s—ti
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Number of bedrooms (residential only) 3 _
Total daily flow (compute @ 150 gal-per bedroom) 1 �
Topography: circle one: % Rolling Steep Slope % of slope
Soil Nature: circle one:,'Loam Clay Other / Depth: feet
Ground Water: At what depth? 0 feet
Bedrock or Impervious Material: At what depth? O feet •
Percolation test: circle one: not required required / rate /vfi} min. inch.
Domestic water supply: circle one: AP Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet •
PROPOSED SYSTEM: Septic Tank .gal. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S): Number of / / Size each feet liy feet -0- e.d/er
Size of stone to be used elf / Depth or Thickness feet
* * 4 * * + »: * * 4 * * * 4, * * * 4 * * * *.* + * * 4 * * * * * * * * * * * * * *
IMPORTANT
...Please—LIST NEW EQUIPMEN'1"1'O BE INSTALLED
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
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(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 dryw-ells
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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.
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.
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I have read the regulations above and agree to abide by these•and all requirements
of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person:
Date: j ^f
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Town of Queensbury •
Building and Code..Department
• Bay at Haviland Road
Queensbury, New York 12801
- .. (518) 792-5832 •
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• BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801 /' O
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SEPTIC DISPOSAL SYSTEM INSPECTION Oar/It P �-C.4
LOCATION ON � � O2 �
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DATE( - 7 )l �,PERMIT NO. D /f/y
SOIL TYRE - Sand - Loam - Clay -
Percolati n Test Required? YES -' NO
Percolation rate - Min/Inch _ . :
TYPE of SYSTEM:
Absorption field, total length
Length of each`\trench
Depth of trenchks ✓ •
Size of gravel \ / •
SEEPAGE PITS{Nuinb of)/
Size- Zft. X ft./ L • `
Gravel size '
PIPING: / Size /Type
Bldg. to tank • A .s �'�7
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Tank to dist. box / 1j`/G'
Dist. box to field pit— Z/C•
Openings sealed? YES ( NO i Partial
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LOCATION/SEPA IONS:
Foundation to ank e)4(' \ r/r;(ft.
Foundation to absorption \“ ft.
Absorption t7 lot line Ni ft.
Separation f pits -.\--6ft.
LOCATI"OR) 0 SYSTEM ON: PROPERTy(circle one)
Front Rear - Left side - Rigpt side -
COMMENTS:/ `\ .
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SYSTEM USE APPROV D YES NO
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