1990-124 BUILDING- PERMIT
TOWN OF QUEENSBURY 90-124
No. rp
WARREN COUNTY, NEW YORKoo
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PERMISSION is hereby granted to ALBERT OUDEKERK w
OWNER of property located at Q4 5( e ay Road Street, Road or Ave.
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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. -
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1. OWNER'S Address is d
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2. CONTRACTOR or BUILDER'S Name
Clifford Green
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3. CONTRACTOR or BUILDER'S Address
10568 Fort Edawrd Rd
S Glens Falls NY 12803
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( ) Steel ( )
7. PLANS and Specifications
No. Sewage alteration to include 1000 gallon tank with tile fields. and #2 stone at
one foot depth as per application and plot plan.
8. Proposed Use
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Sewage alteration y
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$ 25 00 PERMIT FEE PAID —THIS PERMIT EXPIRES OetohPr 5 19 90
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.) -
Dated at the Town of Queensbury this Day,of April 19 90
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
•
TOWN OF QUEENSBURY
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APPLICATION FOR
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'v a - SEPTIC DISPOSAL PERMIT
41111P / D' .''I'D '
APR p 4 1990
DATE 1) I `- `'q'• & C°D
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LOCATION OF PROPERTY FOR INSTALLATION lrl - (15 0, (2 oI
Owner's Name: Q. t tt_d ft<("' p Telephone: (34? 4 I
Address: ? (R a p d. c I Y\ C VCI, I I S \1,y.
Installer's Name: C , l - (15--?r—Q._`--e___ Y\ Telephone: R -' 6 G)
Number of bedrooms (residential only)
Total daily flow (compute (d 150 gal per bedroom) .7< O
Topography: Circle one: lat Rolling Steep Slope % of Slope
Soil Nature: Circle one<San\Jd Loam clay Other /Depth: Feet
Ground Water: At what depth? !v. ' Feet
Bedrock or Impervious Material: At what depth? I) Feet
Percolation test: Circle one: not required required rate 'i in. inch.
Domestic water supply: circle one: Municipal Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption ) 6 C feet
PROPOSED SYSTEM: Septic Tank /.0(`) (') gal. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench .Q feet/Total system length 3 1 feet
SEEPAGE PIT(S): Number. of / Size each feet by feet
Size of stone to be used # ./Depth or Thickness f feet
•
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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 S age Disposal Ordinance.
/•2_e____sl___/\....._
SIGNATURE OF RESPONSIBLE PERSON: cw )
DATE: Ill Jy11
1 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
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 drywells
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 : •
flown Of Qucniur y (15C,
Tom" ✓
BUILDING and ZONING DEPARTMEN. /911
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
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NAME ai 4adeb/-7,./c.i
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LOCATION/, : /`- e
DATE #1/9Q 'PERMIT NO. 00- 04
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SOIL TYPE =44fflit. Loam - Clay -
Percolation Test Required?' YES - NO
Percolation rate -•\ Min/Indh
TYPE of SYSTEM:
Absorption field, total /length •
Length of each trench C� 0
Depth of trenches j-ot 'f
Size of gravel -# _ /
SEEPAGE PITS4Number `'of)'
Size- _ ft. X ft.
- I!
Gravel size , }
PIPING: VSize� Type
Bldg. to tank rim,6- -.
Tank to (list. box 0, 41 y p(/G
Dist. boa: to field/pit\ y /UG
Openings sealed? ( NO Partial
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LOCATION/SEPARATION:
Foundation to tank \ 7 ft.
Foundation to abscrption y„z, ft.
Absorption to lot l'ne %a ft. 1'd
Separation of pits ', ft.
LOCATION OF SYSTEM ON PROPEk2TY(circle one)
Front - Rear - Lef side-Rig t sF�i ide
COMMENTS:
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SYSTEM USE APPROVED • ES NO
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' Building nspector
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THIS PLAN TO BE ON
PROJECT SITE AT
ALL TIMES FOR
THE DURATION OF BuIL D'�, �t
"• REVIEWED BY
CONSTRUCTION - r
DATE
TOWN OFQUEENSIONY ORM DEPARTMENT 1
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TOWN OF OUEENSBUR`!
4• �4.-- RECEIVED
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APR 0 41990
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