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1989-464 r= BUILDING PERMIT TOWN OF QUEENSBURY No, F39- 464 0 '`•� WARREN COUNTY, NEW YORK r- i PERMISSION is hereby anted to CCfi l hPrt IIeKel l o OWNER of property located a{ �SZ I u7�+�np Rr�a�i Street, Road or Ave, in the Town of Oueensbury, To Construct or place a Spwa Ut? Al - ratio — 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 ro 2. CONTRACTOR or BUI LDE R''S blame C V Queensbury Sewer 3. CONTRACTOR or BUILDER'S Address 6MIKKXKXXXX Glens Falls N . Y . 12801 4. ARCHITECT'S Name n 5. ARCHITECT'S Address r c n rt A 6. TYPE of Construction — (Please indicate by X) C l ) wood Frame { ) Masonry 11 Steel I I C 7. PLANS and Specifications No. 1000 gal . tank and 200 feet the field as per plot plan and application . B. Proposed Use Sewage Alteration c n $ 25 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES XjK>7 XXjt I June 20 19 98 91 (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the r town of Ousensbury before the expiration date_) ] c r Dated at the Town of Queensbury t}S,ias= th Day of June 19 `c3 r" c SIGNED BY for the Town of Queensbury Building and Zonfnfi Inspe or TOWN OF QUEEN»SBURY -- �� APPLICATION F'OR.,4 T vr=, SEPTIC DISPOSAL PERNEL . , a 5+el ' . _ PATE DATE LOCATION OF PR ERTY FOR INSTALLATION r. 0 <2 Owner's Name : , o Telephone: Address: lu Installer's Nam ecz�:!- Lt � Telephone : " — c�- Number of bedrooms (residential only) t^ Total daily flow (compute (d 150 gal per bedroom ) 3 Topography: Circle one: la Rolling Steep Slope % of Slope Soil Nature: Circle one: an Loam Clav 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 min. inch. Domestic water supply : circle one: ` ipal Well Other If domestic water supply is a well: Separation : Water supply from septic absorption feet PROPOSED SYSTE 1I : Septic Tanc> gal. ( minimum size: 1 . 000 gal.) �} t 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 /Depth or Thickness .rr 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 Queens Sanitary Sewag bispos Ordinance. SIGNATURE OF RESPONSIBLE PERSON : DATE: i OVER 6;2 - � s 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 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 , rile fields and /or drywells B . Nu system shall be covered before inspection and approval by the Building liispector , Failure to comply with this requirement may r4sulc in the uncoverinb of thy: system by the installer and a fine . f 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 immediate work stoppage . D . Should unforeseen problems during construction prevent proper installa- tion , alteration or repair of an approved system , a new proposal must 1)t submitted to the Queensbury Building Department before further coastruccion , Town of Queensbury BUILDTNC and CODES DEPARTMENT Bay and Haviland Roads Queensbury , New York 12804 flown o/ Qmeen4144ry BUILDING and ZONING DEPARTMENT ' Bay and Haviiand Road. R. D. 1 Box 98 Queensbury, New `fork 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME � /1 V 04_' LOCATION DATED PERMIT NO . SOIL TY> - Sand - Loam - Clay - Percolat:n Test Rewired? YES - , NO percoLati rate - Min/Inch _ TYPE of SYS C Absorption f Id , total le ttx� Length of eac trench k Depth of trenc s Size of gravel. SEEPAGE PITS4N r of ) ._ Size- ft. X - ft .. Gravel size gyp PIPING : Size r,7L Bldg * to tank Tank to dirto box t L Dist. box to fielc + p ' Openings sealed? E O Partial LOCATION/SEPARA ONS : Lr /) . Foundation to k LoL ft f Foundation to Sorption ft . ft. Absorption to of line ft. Separation of pits LOCATION OF STEM ON PROPE Y side e one) Front - gear - Left side - Ri ht side CC7MMENTS : Ji i SYSTEM USE APPROVED N© f Building Inspector 01/86 and Vl *. C� _ j n 1� - � .I � �'� �, � �� � J � � � p1 � tti �1 � � } !�� - �� � T J L .� c � � Y^,.�,�„� � � `� A a w ! �