1986-338 BUILDING PERMIT
TOWN OF QUEENSBURY 86-338
No.
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Carl Bancroft
OWNER of property located at Rhode Island Avenue Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Sewage Alteration rwt
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 Rhode Island Ave.
Glens Falls, New York rt
2. CONTRACTOR or BUILDER'S Name
Carl Dingman
Reliable Sewer Service
3. CONTRACTOR or BUILDER'S Address a
RD #3 cao
Glens Falls, New York r-+
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4. ARCHITECT'S Name R
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( 1
7. PLANS and Specifications
No. 1000 gallon tank, dist. box and 2 6'x8' leach pits per plot and
application submitted.
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8. Proposed Use -
Sewage system for dwelling
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$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES January 1 19 87
(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 23rd Day off` June 19 86
SIGNED BY /
ad u, "-' for the Town of Queensbury
Building and Zoning Inspector C
s F' diP
Jown of QU1UPy APPLICATION FOR SEPTIC DISPOSAL— PERMh�; ��
BUILDING and ZONING DEPARTMENT ) , 6 . J 1
Bay and Haviland Road, R.D. 1 Box 98 ~
Queensbury, New York 12801 • DATE 4 _/-Po - 'f JW4 1 y Ito . r)
A.M. lop 0-ft-e- ALI
LOCATION OF PROPERTY FOR INSTALLATION facJe 7•=2-L--19 A 71
g 9 An 41516
OWNERS NAME d (le� ,,,44---) . . .
ADDRESS j v1 W,`/ , • TEI2F(.34°4 72
INSTALLER' S NAME ` ?Z2 o � -�
p - z. lJ e •-..-r TE L ,5
Number of bedrooms (residential only)
Total daily flow(compute @ 150 gal per bedroom) 1�s"- ()
Topography: 111)
— Rolling - Steep slope - (circle one) % of slope ,-/41
Soil nature:PIrand)- Loam - Clay - OtherSc4 Depth ft.
Grounds water -At what depth? ,, .e. ft.
Bed-rock or impervious material - At what depth? ft.
Percolation test Not required Required - -Rate min-inch.
Domestic water supply - Municipai- Well - Other
Separation. - Watersupply(if well) from Septic absorption ft.
Proposed System: Septic tank jpb c, gal. ( Minimun size, 1000 gal. ) . •
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Tile Field - Each trench ft. Total system legnth ft.
Seepage pit(s) Number of . Size each ' ft X j ft
Size of stone to be used #_ . ,77 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 aZZ requirements of The Town of Queensbury
Sanitary Sewage Disposal Ordinance.
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Signature of responsible person / •.,;c: -:2-
. i wy-, -r-G,,,,4‹. , D i 1 3 e,y
Date
05/86 md/vl c , - 6' X . • ' Le�(A\ �i l
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_loiun of Queen iur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, Nev/ York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME L 4iu w
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LOCATION (� fut2.00
DATE / PERMIT NO. 709 -3 3Y
SOIL TYPE - Sa;2 - Loam - Clay -
Percolati est Required? 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{Numbe of) f,�
Size- ft. X ft.
Gravel ize �z
PIPING: Size Type
Bldg. to tank yl(' J��
Tank to dist. box ��''``
Dist. box to fiel / 't
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank - 2ft.
Foundation to absorption t.
Absorption to' lot line / ft.
Separation of pits a 5-ft.
LOCATION OF SYST OPERTY(circle one)
Front - Rear - eft sid' - Right side -
COMMENTS:
SYSTEM USE APPROVED YES NO
(A/4/12C)
Building Inspector
01/86 and vl
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