1989-430 BUILDING PERMIT
TOWN OF QUEENSBURY No. ^ s�- 4�1� ra
WARREN COUNTY, NEW YORK
00
PERMISSION is hereby granted to 10on St yes
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OWNER of property located at _. 26 Bra don I nn= Street, Road or Ave.
in the Town of Queensburyr To Construct or place a SB 7 Loratj en
at the above location in accordance to application together with plat plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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1 . OWNER'S Address is r '
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Same
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2. CONTRACTOR or BUILDERS Name O
Sanitary Sewer
3. CONTRACTOR or BUILDER'S Address
Glens Falls , H . Y . 12801
4. ARCHITECT'S Name
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S. ARCHITECT'S Address t;c
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6. TYPE of Construction — (Please indicate by M
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[ } Wood Frame I ) Masonry [ l Steel [ } ::3
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7. PLANS and Specifications
No. 1000 gal . tank only as per plot plan and application .
8. Proposed Use
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Sewage ,alteration �
$ py 00 PERMIT FEE PAID — THIS PERMIT EXPIRES June 15 .
ilf a longer period is required an application for an extension must be made to the B u i Idin+g and Zoning inspector of the
town of Queensbury before the expiration date_) `C
Dated at the Town of Queensbury�tsir.�, r ' D y of June 19 89
SIGNED BY for the Town of Queensbury
Building and ping Inspector
TOWN OF QUEENSBURY �
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�ifA-- APPLICATION FOR. TOWN OF QUEENSBURY
RECEIVED
=v <7 � SEPTIC DISPOSAL PERMIT
BLDG. & CODE DEPT.
DATE
LOCATION OF PROPERTY FOR
RIINSTALLATION c;�l ter- 4 ,��./ !4 U-(1 —
Owner's Name: �3 / ( {/ Q J� Telephones Cv
Address: c-), , f� C
Installer's Nam e:C IZL12 JF6L)ex� Telephone: iy-
Number of bedrooms (residential only) 3
Total daily flow (compute (d 150 gal per bedroom )
Topography: Circle one: Flat Rolling Steep Slope of Slope
Soil Nature: Circle one: San Loam Clay Other /Depth: Feet
Ground Water . At what depth ? --- Feet
Bedrock or Impervious Material. At what depth ? r Feet
Percolation test : Circle one of require required rate min. inch.
Domestic water supply: circle one: unici al Well Other
If domestic water supply is a well:
Separation : Water supply from septic absorption feet
PROPOSED SYSTEtiI : Septic Tank 0 D > gal. ( minimum size: Loon gal. )
TILE FIELD : Each Trench r feet/Total system length feet
SEEPAGE PIT(S): Number of / Size each -- feet by feet
Size of stone to be used # -- /Depth or Thickness feet
I have read the regulation on the reverse si this sheet and a r to abide by these
and all requirements of the Town of quee sb ry . anitary Sewa Dispo al Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
DATE :
OVER
Septic Systzni Inspections :
A , All applications for septic system installation , alteration or repair ,
as required by the Town of Queensbury Sanitary Sewage ordinaiice , shall
be submit-tad 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
? . ) location and distance to lot lines
3 . ) location and distance to structures
4 . ) location and distance t+a any water supply
5 . ) size and dimensions of all tanks , distribution boxes ,
cite fields sand / or drywells
G . J , system shall be covered before inspection and approval by the
ltuilding Inspuctor . Failure to comply with this requirement may
result in the uncovering of the system by the installer and a fine
� t up to $ 250 . 00 .
C . An approved copy of the plat plat' 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 instalia—
tion , alteration or repair of an approved system , a new proposal must
i1e Submitted to the Qu� unsbury building Department before further
construction .
"Town of Queensbury
RUILDTNG and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
h.: niarks _ ,
../own o/ Queenizury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
LOCATION
DATE ! PERMIT
SOIL TYPE sand Loam - Clay -
Percolation est Required? YES - HO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field , total length
Length of each tren Yx
Depth of trenches -
Size of gravel:_
SEEPAGE PITS-(Number )
Size- -je—ft. X - f
Gravel size
PIPING : a Type
Bldg _ to tank
Tank to dirt . box - ry
Dist. box to field/ -_
Openings sealed? YE4 NO Partial
LOCATION/SEPARATIONS1
Foundation to tank e f ) £t.
Foundation to absorption ft.
Absorption to lot :c,ine 0( ft .
Separation of pitsft.
LOCATION TEM ( PROPERTY',(circle one)
Front - ear - Leff side - Right side -
CCYtiIMEN �
SYSTEM USE APPROVED YES NO
au nspector
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