1986-719 BUILDING PERMIT
TOWN OF QUEENSBURY No. 86-719
WARREN COUNTY, NEW YORK
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PERMISSION is hereby g ranted to / Norman Facklam
OWNER of property located at 25 Moorwood Drive Street, Road or Ave. 1-1
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 25 Moorwood Drive B
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
Walter Graham
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3. CONTRACTOR or BUILDER'S Address O
301 Main St.
Hudson Falls, NY 12839 0°
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4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( ) c
7. PLANS and Specifications
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No. add two seepage pits 6'x8' and dist. box per plot plan and
application submitted.
8. Proposed Use
Sewage system for dwelling
$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 21 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 21st Day of October 19 86
SIGNED BY j a �. , Q for the Town of Queensbury
Building and Zoning Inspector cpvL.
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Q y APPLICATION FOR SEPTIC D �PO�` 'L��'�ERM=I����'�`°�`�
BUILDING and ZONING DEPARTMENT 9 r c� E 1 ��:i,. `
Bay and Haviland Road, R.D. 1 Box 98. tro
Oueensbury,-New York 12801 - ' DATE /0 /"-2 v -• �- 4'CT ?` $98
LOCATION OF 'PROPERT" FOR INSTALLATION 1M.A2)1 11` 1 Ws
f.;
I OWNER'S NAME 4
ADDRESS og S" ��n-0--r_ dD T E;L 7 Y�' �3 7 . .
INSTALLER' S NAME 4 / '
`L . TEL ') Y7' ? 7S-b
Number of bedrooms (residential only) .
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Total daily flow(compute @ 150 gal per bedroom) L/,S o
Topography: Flat Rolling —Steep slope -(circle one) % of slope
Soil nature: Sand Loam Clay - Other ' Depth ft.
Ground water -At what depth? ft.
Bed-rock or impervious material - At what depth? ft.
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Percolation test - .Not required - Required -- -Rate min-inch.
Domestic water supply Municipa_D—Well - Other
Separation - Watersupply(if well) from Septic absorption - ft..
_ Proposed System: Septic tank tk157-1-g . ( Minimun size, 1000 gal. )
Tile Field - Each trench l bysLam—legnt=` ft :
Seepage pit (s) Number of L . Size each G ft X P ft.
Size of stone to be used # Depth or thickness ' ti- ft.
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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.
Signature ofresponsible person (.Jc G� 1�,�-
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Apo -rum - Pr2-4 04-6(-3 - � gr
05/86 and/vl. . II As Oax_ . •
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Section 'II Septic System Inspections:
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A. All applicationE( 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 nt the system: .
2) location-and distance to lot lines
3) location and distance to structures
A) location and distance toany 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 theiinstaller 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 Oueensbury Building
Department before further construction .
19
_Down o Queenilury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC(�// DISPOSAL SYSTEM INSPECTION
NAME /V D t44A,d f 2 K -A'1
LOCATION (2-4- j\ltcyn Lucon 0 rL.
DATE / PERMIT NO. n - C(
SOIL TYPE - Sand - Loam - Clay - 6
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 PITS{Number of)
Size- ft. X ft.
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box
Dist. box to field/ .
Openings sealed? CIO 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:
xis n.v( TA A-le_
ADow& —( D S 3oK
SYSTEM USE APPROVED ID NO
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Building Inspect r
01/86 and vl
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