1989-432 BUILDING PERMIT
TOWN OF QUEENSBURY No
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to _ R N liaruev
OWNER of property located at 19 Rroadca.cres Road Street, Road or Ave.
in the Town of Queensbury, To Construct or place a S@yJggg Al tE'rati on
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
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2_ CONTRACTOR or BUI LDE WS Name
Sanitary Sewer
3. CONTRACTOR or BUILDER "SAddress
Glens Falls , N . Y . 12801
4. ARCHITECT'S Name
5. ARCHITECT'S Address c .
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fi. TYPE of Construction — (Please indicate 6y X)
I I Wood Frame { ) Masonry { ) Steel
7. PLANS and Specifications
No. 1000 gal tank only as per plot plan and application .
8_ Proposed Use
Sewage Alteration
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$ 2.5 _ 00 PERMIT FEE PAID — THIS PERMIT EXPIRES June 15
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Ilf a longer pareod is required an application for an extension must be made to the $ui#ding and Zoning inspector of the �
town of Queensbury before the expiration dated M
Dated at the Town of Queensbury this Day of _ June 19 89 cm
SIGNED BY for the Town of Queensbury
8uild1ngand 2 n rng Inspector
!'C1WN OF QUEENSBURY 61 1
I lej�* TaWN OF QUEENSiBURY
APPLICATION FOR RECEIVED
SEPTIC DISPOSAL PERMIT JUN 2 1989
1 ,1 , &� IT BLDG. & CODE DEPT,
DATE ' I
LOCATION OF PROP RTX FJJ ,,,OR INSTALLATION
Owner's Name: % � �-Y1"'�"�1 c(. Telephone: `/ �,3 'l o1 Za Lr2
Address:
Installer's Name, + A /►. 7 l T7]�Ld�{� +�� Telephoner
Number of bedrooms (residential only)
Total daily flow (compute (a 150 gal per bedroom )
Topography: Circle one: lat Rolling Steep Slope °6 of Slope
Soil Nature: Circle one Sand Loam Clay Other /Depth: Feet
Ground Water: At what depth ? 1� Feet
Bedrock or Impervious ',Material: At what depth ? Feet
Percolation test: Circle on not�requi_r_e required rate min . inch,
Domestic water supply : circle one: unici Well Other
If domestic water supply is a we
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank gal, ( minimum size : I , 00n gal, )
TIDE FIELD: Each Trench feet/Total system length '� feet
SEEPAGE PIT(S): Number of --- / Size each — feet by feet
Size of stone to be used # r/Depth or Thickness - feet
I have read the regulation on the reverse si is sheet and agr abide by these
and all requirements of the Town of Rue s ry S�\ nitary Sewage ispos Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
DATE:
OVER
Septic System Inspections :
A4 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 hour :, before start
of construction and s 'call include a plot plan showing :
1 . ) the proposed location of the System
location and distance to lot lines
3 . ) location acid distance to srruc-tares
4 . ) location and distance to any water supply
S . ) size and dimensions of all tanks , distribution boxes ,
rile fields ,ind /or drywalls
B . Nu system shall be covered before inspection and approval by the
l: uilding Inspuctor . Failure to comply with this requirement may
r4sult it' tiro uncoverin.; of the sysct-m by the installer and a fine
Uf up to $ 254 . 00 .
C . An approved copy of the plot plan shall be available on the: construction
situ . Failure CO produce said plot plan at time of inspection may
result in an immediate work stoppage .
fl . Should unforeseen problems during construction prevent proper installa—
tion , alteration or repair of an approved system , a new proposal must
he submicLud to the Quuunsbury Building Department before further
Luny ; truccion .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
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BUILDING and ZONING DEPARTMENT
Bay and Haviland Road. R. D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME 4' L
LOCATION 46 t
DATE /j PERMIT NO.
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 11 _—
nepth of trenches -
Size of gravel
SEEPAGE PITS4N-amber of) _..
Size- ft. X
Gravel size '
PIPING : S 'ze` .. Type
Bldg . to tank - P- r-
Tank to list. box
'Dist . box to field/
Openings sealed? S } No Partial
LOCATION/SEPARATI Ss ft.
Foundation to t ft .
Foundation to oxption ft .
Absorption to 10t line
Separation of I `its ft.
LOCATION C7F SvI�TE14 ON PROPERTY (circle one)
Front - Rear Left side - Right side -
-------------
SYSTEM USE APPROVED YES 0
Builc3in Inspector
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