1989-334 BUILDING PERMIT "
TOWN OF QUEENSBURY No
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Floyd Bill ington is
OWNER of property located at 19 River Street 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
SAME
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2. CONTRACTOR or BUILDER 'S Name r
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San i to ry 'Sever
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3. CONTRACTOR or BUILDER 'S Address
Glens Falls , N . Y . IMI
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4_ ARCHITECT'S Name
5. ARCHITECT'S Address
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6, TYPE of Construction — (Please indicate by Xi
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{ ) Wood Frame I } Masonry I } Steel { } p
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7, PLANS and Specifications top
No 1000 gal . tank , 200 ' the field as per plot plan , and application .
S. Proposed Use
Sewage Alteration
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$ 75 00 PERMIT FEE PAID — THIS PERMIT EXPIRES December 1
{If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbu ry before the expiration date_l ...�
of
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Dated at the Town of Queensbury this Day of My 19�
SIGNED BY ~� for the Town of Oueensbury
Building and Zoni Inspector
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OWN OF QUEFNSBURY
APPLICATION FOR 70WW
SEPTIC DISPOSAL PERMIT RE Q V�DNSBURY
DATE -�
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: f 7 C) 61 It i ,u 6 j 0,oJ 'Telephone:
Address: [i /
Installer's Name: A TAI/ 2 c! �; c ,,� Telephone:
Number of bedrooms (residential only) J �!
Total daily flow (compute fd ' 150 gal per bedroom? /
Topography: Circle one: la Rolling Steep Slope % of Slope
Soil Nature: Circle one: an Loam Clay Other /Depth: Feet
Ground Water : At what depth? Feet
Bedrock or Impervious 'Material; At what depth? Feet
Percolation test: Circle one: of require 3 required rate min. inch.
Domestic water supplya circle one: Iunicipal Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank 60 0 gal. fminirnum size: 1 , 000 gala
TILE FIELD: Each Trench feet/Total system length -C-,;2 00 feet
SEEPAGE PIT(S): Number of Size each — feet by —' feet
Size of stone to be used # ;2,- /Depth or Thickness feet
I have read the regulation on the reverse sid is sheet and agr a abide by these
and all requirements of the Town of true s ry S nitary Sewa�e isp sal Ordinance.
SIGNATURE OF ESP NSIBLE PERSON:
DATE:
OVER
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Septic System Inspections :
A . All applications for septic system installatian , alteration or repair ,
as required by the Town of Queensbury Sanitary Sewage Ordinance , shall
be submitted to the huilding Department at least 24 hours before start
of construction and shall include a plot plan showing :
1 . } the .proposed location of tho 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 .appraved 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
be submitted to the Queunsbury Building Department before further
construction .
Town of Queensbury
BUILDINC and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
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BUILDING and ZONING DEPARTMENT
Say and Havriland road. R. D. 1 Sox 98
Queensbury, New York 12801
SEPTIC D SPO L SYSTEM INSPECTION
NAME
LOCATION
DATE _ r�I PERMIT NO. f �
SOIL TYPE - Sand - Loam - Clay -
Percolation 'Test Required? YES - - NO
Percolation rate - Min/Inch -
TYPE of SYSTEMS'
Absorption fie d , total length
Length of each �rench e
Depth of trenche'V
Size of gravel ''t
SEEPAGE PITS41iv a .. Of
Size- ft. X _ 'ft.
Gravel size
PIPING : TYI%eG
Bldg . to tank d
Tank to distw boas w �
Dist . box to field
Openings sealed? YES NO Partial
LOCATION/SEPARA ONS = /�ft.
Foundation to t k
Foundation to sorption fit •
Absorption to of line >� ft.
Separation of pits
LOCATION STEM ON PROPERTY (circle one)
Front _ ar Left side. - Right side Cl
SYSTEM USE APPROVED ES NO
Building Inspector
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