1986-620 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 86-620
WARREN COUNTY, NEW YORK
�s -- /r
Dana BrayJr.
PERMISSION is hereby granted to
OWNER of property located at 15 Twicwood Lane Street, Road or Ave.
K
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.
1. OWNER'S Address is 15 Twicwood Lane
Glens Falls, New York
2. CONTRACTOR or BUI LDER'SName
Sanitary Sewer Service Fes„
H
3. CONTRACTOR or BUILDER'S Address H.
P. 0. Box 224
Glens Falls, New York
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) r
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( )Wood Frame ( ) Masonry ( )Steel ( 1
7. PLANS and Specifications m
No. 2 10'x8' seepage pits per plot plan and application submitted. w
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H.
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8. Proposed Use
Sewage system for dwelling
$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES Sept. 23 1988
(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 ojcf� Sept. 1g 86
SIGNED BY mad < 0_1�« for the Town of Queensbury
Building and Zoning Inspector r�
_town o Queentur,3 1 `•4,
t.
,I I APPLICATION FOR SEPTI }��.
BUILDING and ZONING DEPARTMENT ,`.,,
Bay and Haviland Road, R.D. 1 Box 98 •
`r+ if nn 1�1y
Queensbury, New York 12801 DATE 9 / , d'[ z,e0
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LOCATION OF PROPERTY FOR INSTALLATION-- /
OWNER' S NAME.. (-Potju
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ADDRESS I TJ V (DOcp cc 6,4Air TEL7 -cfY1a-7
INSTALLER' S NAME 1-( op, �L,�'V tr;`v/ c TEL7a/,p -7
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) 6, v-D
Topography: laLt› Rolling .- Steep slope - (circle one) % of slope
Soil nature - Loam - Clay - Other Depth ft.
Ground' water -At what depth? ft. •
Bed-rock or impervious material - At what depth? " ft.
Percolation test - Not required - Required - -Rate min-inch.
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Domestic water supply -(Municipal - Well - Other --
Separation - Watersupply(if well) from Septic absorption ft.
Proposed System: ' Septic tank/ 0O' gal. ( Minimun size, 1000 gal. )
Tile Field - Each trench ` ft. Total system legnth ft.
Seepage pit(s) Number of ) . Size each A) ft X 2 ft
- • Size of stone to be used # ' 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.
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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 Ordinanc
Signature of responsible person
Date
05/86 and/vl
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Section -II- Septic System Inspections:
-A. All applicationd for septid ' 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 d-imens-ion-s- of all-tan-ks, -dis-tr bu-tion------ ..-- = --
boxes, tle 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 t
Department before further construction. •
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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 p ft aety
LOCATION /S 7(A)r,t , 1-6 ocria
DATE 9 / 5( I PERMIT NO. gt - 6 a GS
SOIL TYPE - and Loam - Clay -
Percolatio Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches
Size of gravel 23
SEEPAGE PITS4Number of)
Size- ,4 ft. X ft. Pil< -Ca sr
Gravel size
PIPING: Size Type
Bldg. to tank V " clic
Tank to dist. box
Dist. box to field it
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ii ft.
Foundation to absorption 25-ft.
Absorption to lot line ›,Q ft.t
Separation of pits ft.
LOCATION--:- YSTEM ON PROPERTY(circle one)
Front - Left side - Right side -
COMMENT
xr 59/A, /cov A,/
SYSTEM USE APPROVED /YES NO
Building Inspector
01/86 and vl
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SANITARY SEWER SERVICE -
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LUZERNE RD. • . GLENS FALLS N.Y. PHONE 792-7257
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