1986-718 BUILDING PERMIT
TOWN OF QUEENSBURY No 86-718
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PERMISSION is hereby granted to Lee Pollock
OWNER of property located at 21 Cottage Hill 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 r'
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. CD
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1. OWNER'S Address is
21 Cottage Hill Road
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer Service
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3. CONTRACTOR or BUILDER'S Address Luzerne Road I-'
Glens Falls, New York
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4. ARCHITECT'S Name ro
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5. ARCHITECT'S Address 0
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
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7. PLANS and Specifications W
1000 gallon tank, 1 8'x8' seepage pit per plot and application
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8. Proposed Use co
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Sewage System for dwelling o'
$ 15.00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 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 �y��21st _Day of October 19 86
/��SIGNED BY a Q' ow for the Town of Queensbury
Building and Zoning Inspector
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5ouin of Qturi APPLICATION FOR ,,SEPTIC DtWaRkEcRERMIlauRY
BUILDING and ZONING DEPARTMENT a .,
Bay and Raviland Road, R.D. 1 Box 98 • •i. G EE 1 i°!fj
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Queensbury, New York 12801 DATE 1 0 / '' IP4=f1T "i 411986
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:. .: . LOCATION OF PROPERTY FOR INSTALLATION :L do DrA a e it• . Rjft
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01VNER' S NAME L �_� �,Po-([oic.
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ADDRESS 41 CO ` i _ h 1 t ( t- TEL7 q -140( C
INSTALLER' S NAME SA ik9 i-r-Ai� V
UCr�I ey� 76bevi'G4 TEL70.1.-- 7,9-,S-•7
Number of bedrooms (residential only) ',
. Total daily flow(compute @ 150 gal per bedroom) 3 V o
Topography: Fla Rolling .- Steep slope - (circle one) % of slope
Soil nature: - Loam - Clay - Other Depth Jo ft.
Ground water -At what depth? • . --' ft.
Bed-rock or impervious material - At what depth? ft.
Percolation test - Not required - Required - -Rate min-inch.
' Domestic water supply -_Municipal - Well - Other
Separation - Watersupply(if welly from Septic absorption --- ft.
Proposed System: Septic tank 1000 gal. ( Minimun size, 1000 .gal. )
Tile Field - Each trench . � ft. Total -system legnth —• '' ft.
\ " J ,X $.e)
Seepage pit(s) Number of .../ . Size each -k ft X '&° ft
Size of stone to be used # ,P 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, streazn,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 all requirements of The Town of Queensbury
Sanitary Sewage Disposal Ordinan .
Signature of responsible person 0,,t Aa�
Date l �'�t/r�� f — /0-0 O 9,4i'(' / 1 6-2/O 77 C_
05/86 and/vl /— M k ' arc( Lam.` C(
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Section IISeptic System Inspections:
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A. All applicationd for septid system installation,
alteration or repair, as reauired .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--ai--tan-ks, 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 he
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.
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1/ 1L
awn 01 Queenitury
BUILDING and ZONING DEPARTMENT
-Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
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SEPTIC SPOSAL SYSTEM INSPECTION
NAME
LOCATION 2 ( (?0) (y_t ,P
DATE 40 / ( PERMIT NO. ( j ut�!
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SOIL TYPE - Sand - Loam - C ay -
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 PITS4Numbe of) _ C
Size- Lb ft. X c ft. f l6 x
Gravel size ' ti
PIPING: Size Type
Bldg. to tank r�
Tank to dist. box --
Dist. box to field/..
Openings sealed? NO Partial
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LOCATION/SEPARATIONS:
Foundation to tank / ft.
Foundation to absorption eft.
Absorption to lot line ft.
Separation of pits eft.
LOCATIO OF 'YSTEM ON PROPERTY(circle one)
Front - 'ear Left side - Right side -
COMMEN
SYSTEM USE APPROVED 4010 NO
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Building Inspector
01/86 and vl
' • SANITARY SEWER .SERVICE
LUZERNE RD. GLENS FALLS N.Y. PHONE 792-7257 ,
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