93-207 H
BUILDING PERMIT
TOWN OF QUEENSBURY No. 93-207 p
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to HAROLD AND EDNA MC COMSEY
tenant: Ann Cleveland Iv
OWNER of property located at Ridge Road Street, Road or Ave. N
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in the Town of Queensbury,To Construct or place a Septic 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
Box 4 , Ridge Road (tenant) no
Queensbury NY 12804
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2. CONTRACTOR or BUILDER'S Name ¢'
Walter Decker
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3. CONTRACTOR or BUILDER'S Address 2'. I-'
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) (p
( )Wood Frame ( 1 Masonry ( )Steel ( ) 0
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7. PLANS and Specifications
Septic alteration to include 1000 gallon septic tank, with
No. 125 feet of tile field at 40 ft. lengths with #2 stone
at 2 feet.
8. Proposed Use
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Septic system
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$ 25 .00 PERMIT FEE PAID-THIS PERMIT EXPIRES MAY 17 19 95
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(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the (D
town of Queensbury before the expiration date.)
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Dated at the Town of Queensbury this 17th Day of May 19 93
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SIGNED BY for the Town of Queensbury
Building and Zoning In ctor
SY2-32-
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TOWN OF QUEENSBURY /
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
OF QUEENSb Fee Paid 5
RPCOOVED
Date: • .5/7/3 Ai j�p993Reviewed By
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LOCATION OF PROPERTY FOR INSTALLATION: 5O /X -- �' ®la/ F /p4 gI
Owner's Name: k4/..r/y ® ;- if tin E clergy']Ciit
Owner's Mailing Address:
Installer's Name: (4/ifG r/ ,,e i9 i c 4ic,t Phone #: 772,- 7d'e r
Number of bedrooms (if residential ):
Total daily flow (residential-compute @ 150 gal . per bedroom): .30
Topography-Circle One: Fla Rolling Steep Slope % of Slope
Soil Nature-Circle One: Sand Loaa Clay Other /Depth:
Ground Water-At What Depth? Feet
Bedrock or Impervious Material-At What Depth? /f Feet
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: Municipal Well Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank /LYY gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench O feet//Total System Length /2 feet
Seepage Pit(s): Number of / Size each: ft. x ft.
Size of Stone to be used: # c2- / Depth or Thickness ,2. feet
**************
HOLDING TANK SYSTEM IF REQUIRE
No. of Tanks Size\of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
agency.
****************
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 Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: DATE: 52//77-► 7L3
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 installation,
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 & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks:
* -----.--------- ...
4 OF QuEENst,
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—14 t i-7- 1993
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