88-210 BUILDING PERMIT
TOWN OF QUEENSBURY b
No. 88-210 �
WARREN COUNTY, NEW YORK °
PERMISSION is hereby granted to Ralph Knickerbocker
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OWNER of property located at Luzerne Road Street, Road or Ave.
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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
Same
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2. CONTRACTOR or BUI LDER'S Name
Sanitary Sewer Service (Daniel Drellos) �j'
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3. CONTRACTOR or BUILDER'S Address 0
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P.O. Box 224
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Glens Falls, N.Y. 12801
4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) cD
( )Wood Frame ( ) Masonry ( I Steel ( ) (D
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7. PLANS and Specifications s?,
No. Existing 1000 Gal. Tank, Distribution Box, 2 - 8' x 8' Dry Wells
As per application and plot plan.
B. Proposed Use
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Sewage Alteration
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$ 10.00 PERMIT FEE PAID—THIS PERMIT EXPIRES May 1 19 90
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the ti
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this llth Day of May 19 88
SIGNED BY SO- 0 for the Town of Queensbury
Building and Zoning Inspector
APPLICATION FOR SEPTIC DISPOSAL PERMIT
19
hh / 5UILDING & CODE DEP`r',
DATE
LOCATION OF P OPERTY FOR INSTALLATION
Owner's Name: Telephone: _7q3 —J-0 ®0
Address: 0Pppp
Installer's Name: ` Telephone:
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one: kFLat Rolling Steep Slope % of slope
Soil Nature: circle one: Sand Loam Clay Other / Depth: _ feet
Ground Water: At what depth? feet
Bedrock or Impervious Material: At what depth? _ feet
Percolation test: circle one<not required required/ rate min. inch.
Domestic water supply: circle one: �unicipaWell Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption _ '�� feet
PROPOSED SYSTEM: Septic Tankdo0Q —gal. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S): Number of / Size each feet by feet
Size of stone to be used # / Depth or Thickness _ feet
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
IMPORTANT
...Please...LIST NEW EQUIPMENT TO BE INSTALLED
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
(over)
Section II Septic System Inspections:
A., All applications for septic system installation, alteration or repair, as
required by the Town of Queensbury'Sanitary Sewage Ordinance, shall
be submitted to the Building Department at least Z4 hours before start
of construction and shall include a plot plan showing:
1.) the p'roposed,location of the system
Z.) 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 $Z50.00.
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.
I have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbury Sanit ge Disposal Ordinance.
Signature of responsible person:
---- - Date: �� -- -- - ---- - -- --- - — - ---
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 1Z801
(518) 79Z-583Z
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD.PLACE TO LIVE
Jown of QueenAury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
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SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION
DATE( / PERMIT NO.
SOIL TYPE San - L4
oam - Clay -
Percolation Test Required? YES
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total le th
Length of each trench
Depth of trenches
Size of gravel_ —
SEEPAGE PITS4Number o _
Size- �< X _ cSi e
Gravel size
PIPING: Size Type
Bldg. to tank ` q P[/(- y6?
Tank to dist. ox _ _ 5�'2 35
Dist. box to fi d/pit _ ei
Openings sealed YES NO Partial
LOCATION/SEPA TI S:
Foundation to tank .1_ft.
Foundation t absorp ion - ft. qs
Absorption t lot li ft.
Separation pits ft.
LOCA ION OF SYSTEM ON OPERTY(circle one)
ront - Rea - Left side - Right side -
`-t'aIMENTS:
SYSTEM USE APPROVEDWA —
BUlding
Inspector
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