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1989-417 w BUILDING PERMIT " V TOWN OF QUEENSBURY No. 89= 417 � WARREN COUNTY, NEW YORK PE R NI I SI O N is hereby granted to 0 OWNER of property located at Street, Road or Ave. in the Town of Queensbury, To Construct or place a 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 iA H Sam Lr�7 A H 2. CONTRACTOR or BUILDER 'S Name M Morning Star 3. CONTRACTOR or BUILDER'S Address Glens Falls , N . y. 4. ARCHITECT`S Name C 7O 5. ARCHITECT'S Address CD rw S S. TYPE of Construction — (Please indicate by X) A0 rr ( Y Wood Frame ( ) Masonry ( } Steel ( 1 I'n J. PLANS and Specifications No_ 1000 gal tank , 135 ' the field as per plot plan and application . B. Proposed Use Sewage Alteration rr v G' $ 2s_ OO PERMIT FEE PAID — THIS PERMIT EXPIRES slanuary 7 19 9[} - rr (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the t— town of Queensbury bafore the expiration date.) Pr Dated at the Town of Oueensbury this 9th (Jay of I tnw 19 R h� - c :zlSIGNED BY for the Town of Queensbury Building and Zoning Inspector '1 OWN OF QUEEr- NSBUPY APPLICATION FOR SEPTIC DISPOSAL PERMIT f� T DATE LdCATIdN OF PROPERTY FOR INSTALLATIdN c , (';.-�,/�geL f; JO Ys ' �? Owner's Name: . a f�. _..- -- Telephone, .�' 2 C 5'4'� Address: Installer's Name; ,• l , j am Telephone; � 2 "I-iyC Number of bedrooms (residential only) �— Total daily flow (compute (d 150 gal per bedroom ) Topography; Circle one: Rolling Steep Slope % of Slope Soil Nature: Circle one: Sind , 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 - S min. inch. Domestic water supply: circle one Municipa Well Other If domestic water supply is a we Separation: Water supply from septic absorption feet PROPOSED SYSTEM : Septic Tank ./. e-je gal. ( minimum size: 1 , 000 gal.) TILE FIELD: Each Trench Meet/Total system length / ?S feet SEEPAGE PIT(S): Number of ! Size each feet by feet Size of stone to be used # 2 - /Depth or Thickness .' 1' r 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 rSewage Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSONr�-�_._,. DATE: 1" - ,j OVER } Septic System Inspections : A . All applications for septic system installation , alteration or repair , as required by the. 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 4 . ) location and distance to lot lines 3 . ) location and distance to structures 4 . ) 10catiOn and distance Co any water supply 5 . ) size and dimensions of all tanks , distribution boxes , tile fields and / or drywells I,' . Nu system shall be covered before inspection and approval by the k: uiIding Inspuctar . Failure to comply with this requirement may result it, 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 ❑ n Cho 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- tiun , alteration or repair of an approved system , a new proposal must 11u Submitted to the Queunsbury Building Department before further co :1 :; rrucC ion . Town of Queensbury BUII.DINC and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York 12804 294 ueerr .� hurc�cc��-� ._..low+l of BUILDING and Zor1tNG D��RTQ% 98 'Bay and Haviiand Se Qrk R.D. i B oueensburY, SEPTIC DISPOSAL SYSTEM INSPECTION c NWME_ LOCATION v � f�� PERMIT DATE _ SCIL TYPE an Loam - Clay _ � No Percolation estquixed? YF.a Percolation rate - Min/Inch i TYPE of SYSTEM% total length pbtorption f -elder. exxch40 Length of bkach Depth of tr, ches �- Size of grave 1 SEEPAGE PITS4 camper of} r ft. Size- �Et' Gravel size Size. Type PIPING : Bldg . to tank Tank to dist. box *f Disto box to field/ NO partial openings sealed? kL LATIpN/SEPAFtATI S • �!�© ft. FQunaat oxx�; ion to to rpti to a o eft . Fourrc7atian to t li.ne ,a� ?- ft. Absorption j.tIs ""~`� (C 1Xcle one SeparatXon o5 STEM PROPERTY' LpCATI OF ,Deft side - R`ight side Front _ eax CCM14ENT5 Z f r SYSTEM USE APPROVED YES Bui c7i Inspector 01/86 ma vl • I � ryyl 1 Rmay/ `1 �^" ,�;• REVIEWED Y DATE (a44 4.