1989-426 BUILDING PERMIT
TOWN OF QUEENSBURY No.
WARREN COUNTY, NEW YORK
cLp4,1P �
PERMISSION is hereby granted to y FLOOR MASTER C 1
OWNER of property located a�t ` ' MAHK 1aLAZA=QYTA K ,;R ROAM Street, (toad or Ave.
in the Town of Queensbury, To Construct or place a S3R W A GIR -A I TE]t A` 1019S
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.
t_ OWNER'S Address is
AL BOYCHUCK O
2. CONTRACTOR or BUI LOER'S Name Cap
M
CONDOMS SEPTIC
3. CONTRACTOR or BUILDER'S Address
GLENS FALLS, N.Y. 12801
d. ARCHITECT'S Name
5. ARCHITECT"S Address
G
6. TYPE of Construction — (Please indicate by X)
( Wood Frame I I Masonry I I Steel 11
O
O
7. PLANS and Specifications
No. RESTORE EXISTING DRYWELL ONLY
S. Proposed Use
SEWAGE XX ALTERATIONS
$ 2-% (In PERMIT FEE PAID -- THIS PERMIT EXPIRES
0f a Longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.} SD
N
Dated at the Town of Queensbury y of ,J0111£. 19 89
SIGNED BY for the Town of Queensbury
Building and ZorA ng Inspector
F OWN OF QUEENSBURY
APPLICATION FOR
TOWN OF QUEENSSURY
RECEIVED
SEP'I'[C DISPOSAL PERMIT
JUN 12 1989
BLDG. & CODE DEPT.
DATE
LOCATION OF PROPERTY FOR INSTALLATION 621Jc's t6F^
Owner's Name: � t' 0y 0 10 G Telephone: ��l 3 ' 3-�'' 3
jr
Address: Fi�aa,�rn,�s +F+� - 1'�7A�G�',PL � �r4 C� r�astr'F.�- e4 �
Installer's Name: G Telephone: E "` '�
Number of bedrooms (residential only)
Total daily flow (compute (d 150 gal per bedroom )
Topography: Circle one: Flat Rolling Steep Slope of Slope
Soil Nature: Circle one: Sand Loam Clay Other PlE I /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: it4unicipal Well Other
If domestic water supply is a well:
Separation : Water supply from septic absorption feet
PROPOSED SYSTEM. Septic Tank�y� i5 'l gal. ( 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 # :3 /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 Sanitary Sewage Disposal Ordinance .
SIGNATURE OF RESPONSIBLE PERSON: jU" 'L 'l/
DATE*
OVER
Septic System Inspections :
A . .all applications for septic system installation , alteration or repair ,
as required by Chu. 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 ,
the fields and /or drywells
B . No system shall be covered before inspection and approval by the
Building lnspuctor . Failure Co comply with this requirement may
result in the uncoverinz; of the system by the installer and a fine
of up to ;� 250 ' 00 .
G . An :approved copy of the plot plan shall be available on Chu 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
t) e submitted to the Queensbury Building Department before further
tont3truction .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
_Down 0/ Queen36ury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Queensbury. New York 12801
SEPTIC DISPOSAL
SYSTEM INSPECTION
NAME
LOCATION 12
DATEf 17 - kRM I T NO.
r
SOIL TYPE - Sand - Loam. - Clay
Percolation Test Required? YES - NO
Percolation rate - Min/Inch -
TYPE of SYSTEM :
Absorption field . ,total Length
Length of each trench
Depth of trenches -
size of Caravel
SEEPAGE ;=S{Number ', of) _
Size- ft . X _ ftw
Gravel size 4
PIPING : P. size Type
Bldg . to tank /
Tank to (list , box
Dist. boy: to field/pit
Openings sealed? YES NO Partial
LOCATIONjSEPARATIONS :
Foundation to tank IIIFf ft-
Foundati.on to absorption ft .
Absorption to lot line ft.
Separation of pits fto
LOCATION OF SYSTEM ON P PERTY (circle one)
Front - Rear - Left sid - Right side -
CC MMENTS :
Aee!
I r
0 `
SYSTEM USE APPROVED YE N
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