1989-418 A
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BUILDING PERMIT
17
MCI
TOWN OF QUEENSBURY a
No. 89- 418
WARREN COUNTY, NEW YORKIf
PERMISSION is hereby granted to DEBRA EGGLESTON cr,
OWNER of property located at X MDNTRAY ROAD Street, Road or Ave_
in the Town of Oueensbury, 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. rn
In
1 . OWNER'S Address is r
rn
SAM
s
2_ CONTRACTOR or BUI LDERS Name r
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Cx
QUEENSBURY SEWER
3. CONTRACTOR or BUILDERS Address
GLENS FALLS , N . Y_ 12801
4. ARCHITECT'S Name
5_ ARCHITECT'S Address
6. TYPE of Construction — (Please indicate by X) y
I I Wood Frame l l Masonry f ) Steel f l X
C
7. PLANS and Specifications
No. 750 gal tank , 150 ' the field as per plait plan and application
B. Proposed Use
Sewage Alteration
w
x
c.
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$ 25_ 00 PERMIT FEE PAID — THIS PERMIT EXPIRES January 1 19 90 r
(if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the rr
town of Clueensbury before the expiration date.)
Dated at the Town of O.ueensbury this h Day of June 1989
SIGNED BY ! for the Town of Oueensbury
Building and Zoning 1 spector
f ofc
APPLICAmnON FOR SEPTIC DISPOSAL PERMIT IOIiIEUI & 8lDQ COIF pff"l.
T&T4WOF Q lv� %V
RECEIVED
DATE �i Il •� - '/ Jam' 1989
LOCATION OF PROPERTY FOR INSTALLATION ... � I tic J' G "
Owner's Tlame.r~r� rr- _ ' "' Telephone^:
Installer's Name : „r elephone:
Number of bedrooms (residential or..Iy) _
Total daily flow (compute: @ 150 gal Per bedroom ) �QT.7
. : . .
Topography: circle one FL Rolling Steep Slope 96 of slope
Soil I1:, ture: circle on Loam Clay Other / Depth: feet
GrouAd Water: At what depth? feet
134! +rock or ivupexvious Material: At what depth? feat
Percol:atiou circle one re uj required / rater min. inch.
Domestic water s!.:pply: circle ene "�iunicipa Well Other 4
IF domestic water supply is a Well:
`; aratioa: Watersuppiy' from Septic absorption _ feet
PROI'fJ51; 13 SYSTEM : Septic 'rank gal. (minimum size: 1 ,000 goal.)
TILE: FIELD. Each Trenc:: /R feet / Total system length - feet
SEEPAGE PIT(S) : NumL+cr of / Size each feet by feet
Size of, stone to 1,c usi-cl # / Depth or `llLickness ---lam— feet
1MP +f3RTANT
__.Plea.se...LiST NUW E ulPMEN•r wx'o I3E INSTAIA
(over)
Section II Septic System Inspections.
A. ,All applications for septic system installation, alteration or repair, as
required by the 'Town of Queensbury Sanitary Sewage Ordinance, shall
Lie submitted to Cite Building Department at least 24 hours before start
of construction and shall include a plot plat► 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, 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 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 inxmediate work stoppage.
Do Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
I have read the regulations above and agree to abide by these and all requirements
of the Town of Queeosbury Sanitary Sewage Disposal Onlinance_
Signature of responsible person :
Date: l ,
OF
Town of Queensbury
Building and. Code Department
Bay at Haviland Road
Queensbury, New Yorlc 12801
(518) 792-5832.
D F
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BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 9B
dueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION
DATEQzi;k— PERMIT NO. q
SOIL TYPE S nd - am - Clay -
-
Percolation e t �'� ired? YES NO IncYx
Percolation ra e - Min/ 7--
I
�----
TYPE of SYSTEM:
Absorption field total- .ntJ h �
Length of each t nch
Depth of trenches
Size of gravel
SEEPAGE P ITS4Numbe Of) —
Size- f't. x to
Gravel Size 1z Type
PIP :
Tanag * to tank
Tank to iSt . box
Dist. box to field/ t NO Partial
openings sealed? ES
LOCATION/gEpARATION S
Foundation to tank r & t
t .
Foundation to absor neon
Absorpti_oiti to lot ins (ft
separation of pit
IACATION YST . ON PROPERTY (ci cle one)
Fror:t - Rear Left side - Right side -
COMMENT
ti
SYSTEM L3SE APPROVED E S g
Iris
Iris e or
01/86 and V1
Moor
yin --�. f]SV
0/1
Cook � T"7
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