1989-431 Q0
BUILDING PERMIT
TOWN OF QUEENSBURY
No. 89_ n 3 1 .
WARREN COUNTY, NEW YORRK
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PERM ISSI ON is hereby granted to Gerald Chandler r%3
OWNER of property located at 22 Caroline 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
2. CONTRACTOR or BUI LDE R'S Name tn)
F'r'I
Sanitary Sewer
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3. CONTRACTOR or BUILDER'S Address
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IX Glens Fall , N . Y . 12801
4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction — (Please indicate by X)
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{ ) Wood Frame { } (Masonry I ! Steei
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7. PLANS and Specifications
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No. 1000 gal , tank only as per plot plan and application
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a. Proposed Use
Sewage Alteration
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$ __25 ` 00 _ _ PERMIT FEE PAID — THIS PERMIT EXPIRES jtine 15 m
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the m
town of Oueensbury before the expiration dam.)
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Dated at the Town of Queensbury th is Ray of 19 89
.
SIGNED BY for the Town of Queensbury o
Building and Zoning ctor
TOWN OF QUEENSEL' RY 0� 51' �
f TOWN OF CtUEENSBURY
RECEfVE4D
APPLICATION FOR
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vti; SEPTIC DISPOSAL PERMIT J UN 2 1989
BLDG. & CODE INEPT.
DATE �
LOCATION OF PROPERTY FOR INSTALLATION c�: (_ /T1��y� t. WA- �s�
Owner's Name: rz ,�CIZA-C C Cha&j � E�Telephone: p�i f „�- 03
Address: c;) C/� A i 0Ct A_ j ;4 S7—a e e_ ,f
Installer's Name: .533 /[.1 ( 7_;a 4L11 � `�rC ' ;r .� Telephone: 7 - Z,4s"-�2
Number of bedrooms (residential only) -y
Total daily flow (compute Cd 150 gal per bedroom )
Topography: Circle one: lat Roiling Steep Slope c% of Slope
Sail 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: not required required rate min . inch.
Domestic water supply: circle one: QLugLci Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank I Ooo gal. ( minimum size: 1 . 000 gal.)
TILE FIELD: Each Trench ^— feet /Total system length feet
SEEPAGE PIT(S): Number of f Size each feet by feet
Size of stone to be used # /Depth or Thickness feet
I have read the regulation on the reverse si of is sheet and agree to abide by these
and all requirements of the Town of Quee sbu y S nitary Sewage i I
Ordinance.
SIGNATURE/ OF RES']PONSIBLE PERSON :
DATE:
OVER
1
Septic Svstzni Inspections :
A . 4111 applications for septic system installation , alteration or repair ,
as required by to Town of Queensbury Sanitary Sewage Ordinance , shall
be submit-ted to the Building Deportment at least 24 hours before start
of construction and shall include a plot plan showing :
1 . ) tkee proposed location of the system
location and distance to lot lines
3 , ) location and distance to structures
4 . ) locution and distance to any water supply
5 . ) size and dimensions of all tanks , distribution boxes ,
rile fields and /or drywelis
B . Nu system shall be covered before inspection and approval by the
ASuilding Inspector . Failure to comply with this requirement may
result in the uncoverinb of the systeiii by the installer and a fine
UI. up to : 2S0 . Utz .
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 ,
U . Should unforeseen problems during construction prevent proper installa—
tion , alteration or repair of an approved system , a new proposal must
k,u submitted to the Queunsbury building Department before further
LoLi�jtruction .
Town of Queensbury
BUILDINC and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
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BUILDING and ZONING DEPARTMENT 3 �
Bay and Haviland Road, R. D. 1 Box 98 �d
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM
INSPECTION
LOCATION
DATE / P RM IT NO. `
SOIL TYPE - Loam - Clay -
Percolat on Test Required? YES -- NO
Percolate rate - Min/Inch
TYPE of SYS
Absorption f i ld , total length
Length of each trench
Depth of trench
Size of gravel_
SEEPAGE PITSfNuiab of)
Size- ft. R _ fto
Gravel size
PIPING : S ' ze Type
Bldg . to tank
Tank to dist. box
Dist. box to field/pi
openings sealed? YE NO Partial
LOCATION/SEPARATIONS
Foundation to tank ft.
Foundation to abso ion +- ft.
Absorption to lot 1 ne } . ft .
Separation of pits F- ft .
LOCATION OF SYST ON PROPER (circle one )
Front - Rear - Le t side - Rig t side
COMMIMTS .
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SYSTEM USE APPROVED S
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