1986-250 BUILDING PERMIT
TOWN OF QUEENSBURY No. 86-250
(3 Ca s L 1 r
WARREN COUNTY, NEW VORK
PERMISSION is hereby granted to Michael R. Choppa
OWNER of property located at 2 Dixon Court 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 w
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. m
1. OWNERS Address is 2 Dixon Court
Glens Falls, New York
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R. CONTRACTOR or BUILDERS Name
Morning Star Escavation
Frank Shaw
3. CONTRACTOR or BUILDERS Address
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4. ARCHITECTS Name
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5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by XI
I I Wood Frame ( 1 Masonry 1 1 Steel 1 1
7. PLANS and Specifications co
3 - 6'x8' seepage pits with 113 stone per application submitted.No. w of
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8. Proposed Use rt
Sewage system for dwelling
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$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 19 19 88
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date.)
Dated at the Town of Queensbury this 7� /9
19th Day of ,t� May 19 86
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SIGNED BY a 0 _ 72 for the Town of Queensbury
Building and Zoning Inspector je
.`Down of Quandary APPLICATION FOR SEPTIC DISPOSAL PERMIT
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road. P.O. 1 Box 98 1 TOWN OF QUEENSBURY
Oueensbury, New York 12801 DATE t / /# W 1Ly �' ,D E V iE U
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LOCATION OF PROPERTY FOR INSTALLATION 2 ). . /t9_ A.M. YIO`C' an L j o 191986
� P.M.
OWNER'S NAME /1j115C0� c�G ?1s1s�l( 111�?J}�2i3j41516
ADDRESS �� °9 (. 5 r TEL 7132190
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INSTALLER' S NAME (i. - 6J' , (F✓attXYAcklr/T EL
5/ 7- it
Number of bedrooms(residential only)
Total daily flow(compute @ 150 gal per bedroom) --
Topography: 0 - Rolling - Steep slope - (circle one) % of slope
Soil nature: dr - Loam - Clay - Other Depth ft.
Ground water -At what depth? /+. ft.
Bed-rock or impervious material - At what depth? — ft.
Percolation test - a - Required - -Rate 3 J + min-inch.
Domestic water supply - unicipa Well - Other
Separation - Watersupply(if well) from Septic absorption ft.
Proposed System: Septic tank- gal. ( Minimun size, 1000 gal. )
Tile Field - Each trench ft. Total system legnth ft.
Seepage pit(s) Number of 3 . Size each A ft X ft
Size of stone to be used # 3 Depth or thickness / ft.
IMPORTANT! !
On a separate piece of paper, submit a diagram of the proposed system
with all dimensions shown; including distance from any structure,
distance from property lines and from ANY DOMESTIC WATER SUPPLY or
shore-line of lake, stream,pond or wet-lands. Include all dimensions of
the system, itself.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
I .have read the regulations 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 persoi-T+�,(ii' �Aw
Date
05/86 and/vl
Section II Septic System Inspections:
A. All applications for septic system installation,
alteration or repair, as required by the Town of
Oueensbury 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 he
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 Oueensbury Building
Department before further construction.
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hown of Queend1ury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
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SEPTIC DISPOSAL SYSTEM INSPECTION
NAME_ /' /
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LOCATION xoN C r;
fS 6— a�—
DATE ri/�D,�i�-
o,_ PERMIT NO.
SOIL TYPE - and - Loam - Clay -
Percolation es Required? YES
CPI
Percolation rate - Min/Inch _�
TYPE of SYSTEM:
Absorption field, total length
‘ Length of each trench
Depth of trenches�_
Size of gravel_ —'
SEEPAGE PITS{Numbof) --
Size- _bt_ft. X ft.
Gravel size $yZe Type
PIPING:
Bldg. to tank
Tank to dist. box t
Dist. box to fieldV y
Openings sealed? NO Partial
LOCATION/SEPARATIONS: ft.(
Foundation to tank a J ft.
Foundation to absorption ft.
Absorption to lot line ft.
Separation of pits
Front SYSTEM ON PROPERight scle one)
Front ear Left side - Right side -
CCMMENT
ROVEr
SYSTEM USE APP �" NO
Building Inspector
01/86 and vl
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