1989-447 '�
BUILDING PERMIT
TOWN OF QUEENSBURY
No- 89- 447
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PERMISSION is hereby granted to William Montgomery
OWNER of property located at 1 R`, Main Street 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.
1 . OWNER'S Address is
Same
2. CONTRACTOR or BUILDER 'S Name
.=y
Condons Septic '
T
3. CONTRACTOR or SUIL DER "SAddress
12k Grant Avenue
Glens Falls , N . Y . 12801
4- ARCHITECT'S Name o
=3
5. ARCHITECT'S Address
r—
C-
6. TYPE of Construction — (Please indicate by X) '
{ ) Wood Frame { ) Masonry { ) Steel { ) u
K
f>
7. PLANS and Specifications rvi
No. 1000 gal . tank , 2 6 ' x 8 ' seepage pits as per plot plan and
application
8. Proposed Use
Sewage Alteration
$ 25 , 00 PERMIT FEE PAID — THIS PERMIT EXPIRES June 15 1991
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the rr1
town of Ousensbury before the expiration date.)
0
Dated at the Town of Oueensbu ryzh4o,,15th Day of June 19 89
SIGNED BY h for the Town of Oueensbury
Building and Za ing Inspector
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APPLICATION FOR SEPTIC DISPOSAL PERMIT '26ti�u43 A DLM CODES DEPL
JOWN of QUEEIIsllullr
DA1.L { / _
LOCATION OF PROPERTY FOR INSTALLATION
Owner's Name: ! 1 II/�"1 OQ ,'�eeleph011e: !Tp�. X' 3
Address: I I? MAJ '/V 9 %T" .V Chi � � c f _"�t�0, f7 7A: r�c^�..] G' T
Int.t :..11er's Name: [ 'telephone*
4- -'le
Number of bedrooms (res►idde`ntial only)
Total d:sily flow (compute 150 gal per bedroom)
Tapogruphy: circle one: • lat Rolling Steep Slope 9'a of slope
Soil Nature: circlC one: Sand Loans Clay Other Depth: feet
Grotand Water: At what depth? me d feet
bedrock or Impervious Maternal: At what depth? /� feet
Percolatiots test : circle one: not required required / rate � min. inch.
Do1jLr4::tic water supply: circle one : lvlunicipal Well Other
iI' domestic water supply is a Well:
Separation: Watersupply from Septic absorption _ _ feet
PROPOSED S4' S`I l Tv1 : Septic Tank 16Q Cl .__.. gal. (minimum sire: 1 ,000 cal.)
TILL FIELD: Each Trench feet / Total syste/m length �}- feet
S>ri PACE PIT(S) : Number of �_ / Size each 4/0 feet 4y feet
Size of atone to Uri used it / Depth or `fliickness :> feet
I M P 0 a *rA N "f
_._l1lea.sr__..LIST NEW 1•:[ UIPM :N1&rO TSE INSTALI.I_13
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(over)
Section Il Septic S-Ystem lnsprectionsi
A. All applications for septic system installation, alteration or repair, as
required by Like `!'own of QutenaUury Sanitary Sewage Ordinance, shall
lae: submitted to the Building Depiuwttzluext at least L4 hours before start
of construction and shall include a plot [flan ::Mowing;:
1 . ) the proposed Jocation of the system
2. ) location and distance to lot lines
3 . ) location and distaneti to structures
-l _) location and distance to any water supply
5.) size and dimensions of all tanks, distribution
boxes, tilt fields and/or drywalls
B. No system shall be covered before inspection and approval by the building
Inspector. Failure to comply with this requiremt_nt may result in the
uncoveriiig of the systene by the instullur unit a fines of up to $z5o.00.
c. An approved copy of the plot Plan shall be available on the construction
site, l ailure to produce said plot plan at time of inspection may result
in an inlinediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system , a new proposal must be subnxitted
to the Queunsbury Building Department before further Construction,
l have read the regulations above and agree to abide: by these and all requiretnents
of the 'Town of Quetenabury Sanitary Sewage Diupos:al Ordinance.
Sigreature of responsible person:
Date:
Town of Queensbury
Building and Code, Department
Bay at 1-Iaviland Road
Queensbury, New York i 2501
(518) 792-5832
awn 0/ Queenj "ry
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTC-E`i/�1,� �INSPECTION
NAME-
LOCATION
DATE / PERNTT NO . '-
SOIL TYPE - Sand - Loam - Clay
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption f3\eld , total. length
Length of each, trench
Depth of trenhes '
Size of gravel_
Ik
SEEPAGE v ITS4N er of)
Size- 6 £t. X Ivq ft. , �
Gravel size °
PIPING :W { 1 e Type
Bldg _ to tank
.% ;
Tank to disco box fi
Dist. box to f ield et
openings sealed? ES 13O Partial
LOCATION/SEFARAT oNS :
Foundation to t k �f t.
Foundation to sorption ' ft .
Absorption to of line 1L� ft =
Separation of pit 1' 7ft.
LOCATION oN PR RTY (circle one)
Front Rea Left side Right side
COMMENT .
G� JC2a
SYSTEM USE APPROVED YES WO
Bux 1 nspector
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