1989-383 1
BUILDING PERMIT
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TOWN OF QUEENSBURY
No- 894 383 ?
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Richard Sawyer
OWNER of property located at 11 nrtarry irmccin,g Street, Road or Ave.
in the Town of Queensbury, To Construct or place a SiPalrag�alteration
at the above location in accordance to application together wilth 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 BU1 LOE R'S Name
Action Septic Service
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3- CONTRACTOR or BUILLIER 'S Address
Glens Falls , H . Y . 12801 ri
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A. ARCHITECT'S Name �+
5. ARCHITECT'S Address
13- TYPE of Construction — (Please indicate 6y X) AC
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I 1 Wood Frame { ) Masonry { I Steel { }
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7- PLANS and Specifications
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No, Existing 1000 gal . tank, 135 ' the field as per plot plan and
application . to
$, Proposed Use
Sewage Alteration
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$ 25000 PERMIT FEE PAID — THIS PERMIT EXPIRES December 1 19 e
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(If a longer period is required an application for an extension must be made to t h a Building and Zoning inspector of the
town of QueensburY before the expiration date.}
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Dated at the Town of Queensbury this t Day of May 19gq a
SIGNED BY for the Town of Queensbury
Building and Zoning frifiPector
TOWN OF QUEE SBURr
APPLICATION FOR �(
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' ✓��"`� '� SEPTIC DISPCISAL PER.INFI' - - � T AWN RE Q,� �S+BUfij4'
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DATE / ram' G SLOG, gr CODE
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LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name:., r Telephone:
Address• ,',.
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Installer's Name: I-rr�' ��, � Oteo7 f66 Telephoner �1 �
Number of bedrooms (residential only) 4.
Total daily flow (compute (d 150 gal per bedroom ) e55�' 1451
Topography: Circle one: la Rolling Steep Slope % of Slope
Soil Nature: Circle one: and. Loam 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: Munici al Well Other
If domestic water supply is a wel :
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic 'Panic /va4'Pov - aI. (minimum size: 1 ,000 gal.)
TILE FIELD : Each Trench feet/Total system length / - feet
SEEPAGE PIT(S): Number of / Size each feet by feet
Size of stone to be used # L;Z /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 Sanita y Sewage Disposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
DATE:
1
OVER
Se tic System inspections :
A . All applications for septic system installation , alteration or repair ,
as required by the 'Town o € 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 10L lines
3 . ) location and distance to structures
4 . ) location and distance to any water supply
5 . ) size and dillIensions of all Lanks , distribution boxes ,
tile fields and /or drywells
13 , No :system shall be coverad before inspection and approval by the
l: uiiding lnspector . Failure to comply with Chis requIremcnt may
result in Chu uncovering of the SysLe[it by the installer and a fine
of up to $ 250 . 00 .
G . An approved copy of the plot plan shall be available on the construction
situ . Failure to produce said plot plan at rime of inspection may
result in an immediate work stoppage .
D . Should unforeseen problems during construction prevent proper installa-
Cion , alceration or repair of an approved system , a new proposal must
be submitted to the Quucnsbury Building Department before further
construction ,
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and llaviland Roads
Queenabury , New York 12804
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BUILDING and ZONING DEPARTMENT
Bay and Havi{and Road, R. D. 1 Sox 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME L�
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LOCATION /�(� 4
PERMIT NOOL �a
SOIL TYPE Sand - Loam - Clay -_
Percolatio t Required? YES - NO
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Percolation,{ rate - Min/Inch -
TYPE of SYS
Absorption f i Id , total length'
Length of eac trench
Depth of trenc es
Size of gravel V .
SEEPAGE PITS4N er of]
Size- ft. X ft.
Gravel size
PIPING : Size Type
Bldgo to tank
Tank to dist , box
Distm box to field/ !fir
Openings sealed? NO Partial
1,CCPTxON/SEPARATIONS : ft.
Foundation to tank
Foundation to absorpt! n ft-
Absorption to lot lin ft .
Separation of pits ft.
LOCATION OF, SYSTEM PROPER (circle one)
Front ear - f side - Ri t side -
OOMMENTS :
SYSTEM USE APPROVED NO
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P m0. Box 1430
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