1986-406 BUILDING PERMIT
TOWN OF QUEENSBURY No. 86-406
OG\ WARREN COUNTY, NEW YORK
�� e LaFreniere
PERMISSION is hereby granted to Lorrain
OWNER of property located at 12 Luzerne Road 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
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. ti
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1. OWNER'S Address is 12 Luzerne roadH.
Glens Falls, New York
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2. CONTRACTOR or BUILDER'S Name _ n
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3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
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5. ARCHITECT'S Address ro
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6. TYPE of Construction—(Please indicate by X)
( 1 Wood Frame ( ► Masonry ( 1 Steel ( 1
7. PLANS and Specifications
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No. 2 6'x8' xxxx seepage pits dist. box per plot and applicationCrg
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8. Proposed Use
Sewage system for dwelling
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$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES JUly 15 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 Queensbury before the expiration date.)
Dated at the Town of Queensbury this 15th Day of JUly 19 86
SIGNED BY a-_/), - for the Town of Queensbury
Building and Zoning Inspector
Down of Qucin.i1ury APPLICATION FOR. SE�T��I,c iS$POSAL PERMIT
BUILDING and ZONING DEPARTMENT4 �FEENUet '
Bay and Haviland Road, R.D. 1 Box 98 U F. Ti;
Oueensbury, New York 12801 DATE / 1 �� Li
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LOCATION OF PROPERTY FOR INSTALLATION .ItF,1�(L`. /Zj
S�d'�L ,pro f L1A,�1i1; ,JJPP�da JJ;�b}, 1 4f1
,7404
OWNER' S NAME 1.�®cG.a`�� Q-r- ' ��C�
ADDRESS l k1.��,.C' °�1P� Re:S/
GT: j ) ci . ) <�] TEL I �f O
I NSTALLER' S NAME6)S GYrrr9 ^ r34, �4uI Y.. Stel 1"� nf- 3r TEL /°1 " O�
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Number of bedrooms (residential only) 3 .
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Total daily flow(compute @ 150 gal per bedroom) L/SQ
. Topography440
Rolling .- Steep slope - (circle one) % of slope
Soil nature: Sand Loam -Clay '- Other Depth ft.. •
Groundwater -At' what depth? i( A ft. •
Bed-rock or impervious material - At what depth? V ft.
Percolation test• Not required - Required - -Rate t min-inch.
Domestic water supply - unicipal - Well - Other '
Separation - Watersupply(if well) from Septic absorption ft.
Proposed System: Septic tank 'WO gal. ( Minimun size, 1000 gal. )
Tile Field - Each trench ft. Total system legnth ft.
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Seepage pit (s) Number of 2 , Size each 6'„ ft X j ft
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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 •
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the system, itself .
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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 person
05/86 and/vl
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Section II Septic System Inspections:
• A. All applicationd for septic system installation,
alteration or repair, as reauired by the Town of
Queensbury Sanitary Sewage Ordinance, shall be
submitted to the Buildina 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.
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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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Jown of Queenat ur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
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NAME (/t, i.
LOCATION ai.A.r..e....- / '
DATE --//5-/ %Q PERMIT NO. o 6 -' (P
SOIL TYPE - Sand - Loam - Clay -
Percolation Test 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 PITS4Number of)
Size- ft. X ft.
Gravel size
PIPING: 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:del
- Ce7"-7.`"
/4,6-2/1... jert,c, A----44.,4
t),--4, 1A1,6,'ei_ ":.. -off
SYSTEM USE APPROVED YE NO
Building Inspector
01/86 and vl
Jown of Queeniur/
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME /
LOCATION /2 �-Cy.'71' ,
DATE 7-7/y / Ky PERMIT NO.PG-- Lid b
SOIL TYPE 10 - Loam - Clay -
Percolation -st 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*Numb r of)
6P
Size- ft. X j ft.
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box _
Dist. box to field/pit -.4011110
Openings sealed? YES NO Partia
LOCATION/SEPARATIONS:
Foundation to tankft.
Foundation to absorption - '6 ft.
Absorption to lot line 3O( ft.t
Separation of pits 1Vft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS: n
1441144.12,
SYSTEM USE APPROVED YES NO
tj4113'..1-41 -
Building Inspector
01/86 and vl
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