1986-617 BUILDING PERMIT
TOWN OF QUEENSBURY No. 86-617
WARREN COUNTY, NEW YORK
aci Le`AD-1—5S JayWasserman
PERMISSION is hereby granted
to
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OWNER of property locate t! 1 / < BaY 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.
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1. OWNER'S Address is 294 Bay Road
Glens Falls, New York n
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2. CONTRACTOR or BUILDER'S Name
Robert Ellsworth
3. CONTRACTOR or BUILDER'S Address td
RR #1
Lake George, New York
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4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
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( )Wood Frame ( ) Masonry ( 1 Steel ( .1 - 0
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7. PLANS and Specifications rt
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No. 1000 gallon tank, 1 4'x8' seepage pit per plot and application rt
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8. Proposed Use
Sewage system for dental office
$ 10-00 PERMIT FEE PAID —THIS PERMIT EXPIRES Sept. 23 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 23rd Day of Sept. 19 86
SIGNED BY 7)144, a „a ., for the Town of Queensbury
Building and Zoning Inspector /
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TOWN OF'QUEE iSEBURY
awn o` Quernitury APPLICATION FOR SEP RI El j i _ I
BUILDiNG and ZONING DEPARTMENT - "°
Bay and Haviland Road. R.D. 1 Box 98 9 qi ,M
3 _,
Oueensbury, Nev York 12801 DATE /. 1. �d2e."" '"�
7J8j9 1) iv-11213141516
LOCA1 J ON OF FROPERTY FOR INSTALLATION ' ° ° ' VI • a 0 a
OWNER'S NAME ,3 V Z� [A,C4 S
I ?�.33�5�.� t-lr��
ADDRESS j %,t✓J Ka, TEL ,,E12 ,i
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INSTALLER' S NAME
ren er
b1�r- I 14 �� -+ t� ✓a l•' • TEL 7Pdc) /<'
Number of bedrooms(residential only) e—) .
• Total daily flow(compute @ 150 gal 'per bedroom)
Topography:- Rolling - Steep slope -(circle one) % of slope
Soil nature: Sand Loam '- Clay - Other Depth ft.
Ground water -At what depth? 1 )- ft.
Bed-rock or impervious material - At what depth? ft.
Percolation test - Not required - Required - -Rate min-inch.
Domestic water supply *nicip!-D- Well - Other
Separation - .Watersupply(if well) from Septic absorption ft.
Proposed System: Septic tank ) -ot7. gal. ( Minimun size, 1000 gal. )
Tire Field - Each trench ft. Total system legnth ft.
• Seepage pit (s) Number of 1 . . Size each ft X X ft R trA
Size of stone to be used f 3 Depth or .thickness a ft.
IMPORTANT I
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.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *. * * * * * * *
1 ho-'c °`c. . Z+:r c,: ti':( rr ier'se cfd Of this sl:c( and ag]•ce
to abide 1,y these and a7 Z recuirenent s cf The Torn of Queer,shury
Sanitary Se 'ace Z:isposaZ Ordinance.
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Si or,cturc - of rc rr.or il-,Ze- rrr:o,: - U C.�Lo
05/86 and/v] • •
Section II Septic System Inspections:
A. All applicationg for septid 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 inspecticn 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.
•
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 4P-Li
LOCATION 9le
DATE LO? / 0 ERMIT NO. PI - (a / 7
SOIL TYPE - San Loam - Clay -
Percolation Test Required? YES N
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench ----
Depth of trenches '
Size of gravel
SEEPAGE PITS{Number of) _ 1
Size- V ft. X _ ft.
Gravel /size ' q7,-
PIPING: Size Type
Bldg. to tank r 10
Tank to dist. box _
Dist. box to field/ it
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption lc-ft.
Absorption to lot line /0 ft.
Separation of pits -- ft.
LOCATION OF SYSTEM ROPERTY(circle one)
Front - Rear L ft side Right side -
COMMENTS:
SYSTEM USE APPROVEDglit
NO
(144/a,t :MET
Btra ding Inspector
01/86 and vl
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