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1990-028 BUILDING PERMIT TOWN OF QUEENSBURY -0 No. 90-28 0 WARREN COUNTY, NEW YORK 3._K.\t-A - --cp3 Co PERMISSION is herebygranted to Charles Matteson IV 1 N I OWNER of property located a Mtn. View Lane Street, Road or Ave. in the Town of Queensbury,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 c) 2. CONTRACTOR or BUILDER'S Name rrI Vf Sanitary Sewer Service 1 3. CONTRACTOR or BUILDER'S Address rn LA 4. ARCHITECT'S Name 5. ARCHITECT'S Address 3 cI. 6. TYPE of Construction—(Please indicate by X) C -1. ( )Wood Frame ( ) Masonry ( 1 Steel ( ) fD I- 7. PLANS and Specifications fD No. Existing 1000 gal . tank to be replaced as per application and plot plan. V 8. Proposed Use Sewage Alteration cm $ 25.00 PERMIT FEE PAID—THIS PERMIT EXPIRES February 14 19 92 rD (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the t8 town of Queensbury before the expiration date.) fD b Dated at the Town of Queensbury this 14th Day of ' February 19 90 m cu SIGNED BY ) I CL � n-d for the Town of Queensbury p Building an to ,ning Inspector / I Q VN OF QUEENSPURY - _ ri--1 ` <- APPLICATION FOR v S ) SEPTIC DISPOSAL PERMIT d. i e r",- Af' 2,;) FEB 1.4 1990 , DATE — t7�f /990 - ,ti r-`il:, "'' . ;.''ti'',. . 'BLDG. e. CODE DEPT, LOCATION OF PROPERTY FOR INSTALLATION Owner's Name:cbhI. ,4 ) 'c r / Telephone: "79) - 7 '7 6 2 Address: / 9 A T 0' ' fr ,./ Z7&Vk_ Installer's Name: (' �i1'6/� Telephone: 7Q 9 , In ,/ ) ',V 1 Number of bedrooms (residential only) 2 — Total daily flow (compute C. 150 gal per bedroom) �? 0 Topography: Circle one` Rolling Steep Slope % of Slope Soil Nature: Circle one: ? Loam Clay Other /Depth: Feet Ground Water: At what depth? 'f Feet Bedrock or Impervious Material: At what depth? — Feet - Percolation test: Circle one: o require required rate min. inch. . Domestic water supply: circle one: 'Iuna Well Other If domestic water supply is a well: Separation: Water supply from septic absorption feet PROPOSED SYSTEM: _ Septic Tank I° gal. (minimum size: 1.000 gal.) 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 feet ************************* I have read the regulation on the reverse sid his sheet and agr- - : :bide by these and all requirements of the Town of Queensbu y S nitary Sewage,, II is osa Ordinance. _ SIGNATURE OF RESPONSIBLE PERSON: . :a/v(Ad . 4�� � DATE: J l D • . 17410/C OVER • l • • • • 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, tile fields and/or drywe-lls 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 immediate work stoppage. • D. Should unforeseen problems during construction prevent proper installa— tion, alteration or repair of an approved. system, a new proposal must 'be submitted to the Queensbury Building Department before further construction. • • Town of Queensbury BUILDING and "CODES DEPARTMENT Bay and Haviland Roads Queensbury, ,New York 12804 Remarks: • _town of Queen3ur/ BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME 1iL' TC..: d1A LOCATION V� O,?'-) ( 144. fl DATE Z 1 I`-i/!v PERMITNO. 90—r SOIL TYPE - and - Loam - Clay - Percolation TestRequred? YES - NO Percolation rate'~, Min/Inch TYPE of SYSTEM: Absorption field, total length Length of each trench Depth of trenches Size of gravel SEEPAGE PITS- Number of) Size- ft. X Gravel size PIPING: :i Size Type Bldg. to tank 4 - (/;44D Tank to dist. boxti' Dist. box to field/pit Openings sealed? YES NO Partial LOCATION/SEPARATIONS: Foundation to tank it) ft. Foundation to absorption ft. Absorption to lot, line ft. Separation of pits ft. LOCATION OF SYSTEM ON PROPERTY(circle one) Front - Rear --Left side - Right side - COMMENTS: v .53 SYSTEM USE APPROVED Y,U, j NO . Building Irpector • 01/86 and vl _ s! Cili too itO V 11) Ll� V„a vv,) N©::::)r u s(O� . PvL i I-14- Cc i .