1986-193 BUILDING PERMIT
TOWN OF QUEENSBURY No 86-193
WARREN COUNTY, NEW YORK
PERMISSIO is ere granSto 3 grddon Hunter
35yRidge St. Street,Road or Ave. ,4
OWNER of property located at
Sewage Alt.
in the Town of Queensbury,To Construct or place a
at the above location in accordance to application together with plot plans and other information hereto filed and C
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is 353 Ridge St.
Glens Falls, N. Y.
2. CONTRACTOR or BUI LDERS Name
John White Bulldozing and Backhoe l„
u,
3. CONTRACTOR or BUILDER'S Address
Ganseyoort, N. Y.
m
n
4. ARCHITECT'S Name
5. ARCHITECT'S Address
co
6. TYPE of Connruc[ion—IPlmse indicate by X)
N
I 1 Wood Frame ( )Masonry I )Steel 1 ) 00
N
9
Y
7. PLANS and Specifications additional 70 ft. leach field with #2 stone per
No. application submitted.
H.
0
8. Proposed Use
Sewage system for dwelling
$ 10.00 PERMIT FEE PAID—THIS PERMIT EXPIRES May 5 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 Oueenslwry before the expiration date.)
Dated at the Town of Queensbury this `]5�thh ems. ' eDay of May 19 86
SIGNED BY //f O_CAI O 4 for the Town of Queensbury
Building and Zoning Inspector p ;
ra
_awn of Queendtury TOWN OF QUEENSB -
BUILDING and ZONING DEPARTMENT I"' (j'� f6 (� II \I .
h . 2-
Bay and Haviland Road, R.D. 1 Box 98 'un�U( LS IC,g LS I! SSI
1 3 Gueensbury, New York 12801 APR 3 01986in
AM. /Uadr6. g Iva
71819 m11218)415I
SEPYTIC DISPOSAL PERMIT APPLICATION
Owner 's Name , ,L/ Ni--f Tel.
Address 36"3 .ed
Person/Firm installing system &9A' /2 /4 ,y f ,a4 6:ans ;.r
y Number of bedrooms (residential only) it •f /Y e Mon.,
Total daily flow: (compute @ 150 aal.per bedroom per day)_ 600
Topography: flat - rolling -O- (circle one) Decree of slope _%
Nature of soils: sand- oamclay- other- Depth ft.
Ground water-- at what depth? (o ft.
Be w ft.
P c - require min/inch.
Domestic Water Supply Municipa - Well - Other
IMPORTANT! -
On a separate piece of paper, submit a diagram of the proposed septic
system with all dimensions; including distance from any structure,
distance from property lines and distances from any domestic water
supply or shore-line of lake, stream, pond or wetlands. Include all
dimensions of the system itself.
Description of proposed system:
Septic tank size —gal:EKCSTING-Jlo C1LALAek
Tile field- Length of each trench_ ft. Total field 70 ft. /OoiTTo,vAc.
Size of stone I
Seepage v •r ! ) Numb / Si cee�rx ft. Size of stone* •
Any contractor, corporation, individual,Etc. , engaged in the
construction of a Sanitary Sewage Disposal System, who covers the
same before inspection, does not have an approved Permit, or varies
from the approved application, will be subject to a Penalty of $250
as provided for in Section 6. 010 of the Town of Queensbury Sanitary
Sewage Ordinance.
/2� ia/�f i30 Tad
Signature of Applicant Date
01/86 and/vl
St-6 > 5 LAn-
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 be
available 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.
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flown of Queenlbury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road R.D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME k/Ci,(/r Fit—
LOCATION ft1 n (HJ JOB-DATE I PERMIT NO. p 193
/y
3
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total le* 7U
Length of each trench — 3 O
Depth of trenches
Size of gravel RZ
SEEPAGE BEN of) _
Size- X ft.
Gray size
PI ING: Size Type
Bldg. to tank
Tank to dist. box
Dist. box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank _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: [/ /n� �,,
14OAHrt0A' /- />v0 L&Iw4F
• f p,Cv Vbtl I N c PGcrh'R o d
O cil1Y5bWG'z- aMl dip_
OWti!>n tutu- Do go tawlinz. P 70A-Iit
p se-4-5 SA-0-Al
SYSTEM USE APPROVED SO NO
Building Inspect
01/86 and vl