5801 BUILDING PERMIT
TOWN OF QUEENSBURY
No. ,g01
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Ted Hans
OWNER of property located at Mason Road (Cleverdale) Street,Road or Ave.
H
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.
to
1. OWNER'S Address is
Cleverdale, N. Y.
2. CONTRACTOR or BUILDER'S Name
John Mason
3. CONTRACTOR or BUILDER'S Address
Cleverdale, N. Y.
4. ARCHITECT'S Name
O
5. ARCHITECT'S Address O
Iv
n
I�
6. TYPE of Construction—(Please indicate by X) �p
( )Wood Frame ( ) Masonry ( )Steel ( )
rt
IZ
7. PLANS and Specifications
No.
1500 tal. concrete septic tank, 600 gal. concrete
receiver with pump and 2" line to drainfield
per gkPtclh and application submitted.
8. Proposed Use
Sewage system for dwelling
$ 5. 00 PERMIT FEE PAID—THIS PERMIT EXPIRES Sept. 1 19 79
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the (D
town of Queensbury before the expiration date.)
rt
Dated at the Town of Queensbury this 1 6th Day of May 19 7 9
^' Fi
SIGNED BY c - for the Town of Queensbury N
Building and Zo ng Insp ctor
APPLICATION FOR A PLTNIT TO CONSTRUCT, ALTER OR ENLARGE A SEWArE DISPOSAL SYSTEM FOR
A PRIVATE RESIDENCE WIT= THE LAKE GEORGE PARK IN THE TOWN OF
1. Name and railing address of owner:
-roWN OF QU NADURY
2. Specific location of property: - Y t ► .lj %9
3. Application is for: (check one) A.M.
?1819p.Opp.IS
2111213111106,.
New construction Alteration or enlargement of existing csposal system
4. Description of building: Number of bedrooms
5. Property line dimensions, or total area of property:
6. Topography:
( flat, rolling, steep slope, gentle slope, etc.)
7. Nature of soil. (Describe to a depth of 5 feet below bottom of leashing device.)
Give soil type, distance to groundwater, distance to bedrock.)
8. a) A soil percolation test may be required. For details on procedure, refer to
"Individual Household Systems - Standards for Waste Treatment Works" - N.Y.S.
Department of Health.
b) Percolation test result:
(Please attach test notes.)
9. Please attach a carefully drawn plan of the proposed sewage disposal system.
Give all dimensions, including distances to lot lines, wells (yours and
neighbors) , streams, and Lake George if applicable.
10. The Lake George Park Commissioon reserves the right to inspect the completed system
before backfilling. The owner is required to notify the Cormission at least 24
hours in advance of backfilling, to facilitate the final approval inspection.
11. Construction will begin on by
— (Date) ( Contractor)
application and attached plans dated I hereby agree that if this p -
or any amendment or revision thereof, are approved, installation of sewage disposal
facilities will .be made in accordance with the details thereof as shown on such
approved plans, within 180 days of the above date. One extension of 180 days will
be allowed if applied for and secured in writing.
•
(Sjgpature of owner) Date)
The Lake George Park Cotrzrri.ssion has reviewed the plans and site location for this
project and accordingly recommends approval.
By:
R. E. Cowen, III, P.E. Date
712' Asst. Hydraulic Engineer
TOWN OF QUE ENSBUR
BUILDING & ZONING DEPT..
QUEENSBURY TOWN OFFICE BUILDING
BAY & HAVI LAND ROADS,
GLENS FALLS, NEW ?OM 12SO
. 1.1CATION FOR A PERMIT TO COSTRUCT, ALTER on ENLARGT-,
: T',"--.GE DISPOSAL 3YSTEM WITHIN THE TC:iN OF (ZUEENSBUTI%
C:JANTfE. NAME 77_0 .W45-
ES..› z-O
't1 HONE z ONNER S AAME L2!1/3-
OF 3 ED 7,1C4>Nrs
(MINDER? (YiS OR NO TOPOGaAPHY °gLAT;)Rct STti:Ft.
GENTLE SLOeF„ OTHER
,
,ATME OF SOIL: CLAY, SANDY, LOAM GRAEL, RCM,. 1"^ Z/3401
ON TEST WATER SUPPLY: ..clUNTC:1 kcy":ii Fit
4
WAGRAM OF RR(.P.,CED SEPlIC
vI /F-1)
'PERTINENT I NFORMT I ON
: HEREBY AGREED THAT IP THIS APPL:TAT1 ON AND PL P., LT -:•R i •
(Yr: '; FAc 7 scAi :;1•QE
•171-'I DETAILS SHOWN
• :2:4IT FEE TS
7
, y SIGNATURE OF Al-PL --.=;A;47
'
TE 1-171 7-/J
TOWN OF QUEENSBURY
Building Department"
Inspectors Report Date �- P/7
Nam, `7,?0 )4v41- "
Location --$T
Permit No. jsre 0 j Weather
Per Cent
Complete Remarks
Excavation
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing •
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg.
Rough Htg.
Relief Valves
Wall Board .
Ext.Porches
Finished Floor
Interior Trim
Stairs&Railings
Cellar Dr.Tile
Concrete Floors
Plhg.Fixtures
Gar.Fireproofing
Door Closers
Chimney
Water Meter Inst.
Septic Approval /
lei zdi/L---__,-.
Building Inspector
REMARKS
://041(4'd /014 'c- °rL9e'.7'6t(
75-0 am e_, Po-e...../
-'--'-----7—c- /4/, ?it/
perk61 ---f i
tie' ao - /-
-,, „--- it"FLA 1-0 HA 7-t 0 r vi- •', .,.-
)1E'NuM s AND FILL
02 1 . • . o . o I, ,,0 cp „ -.V , -"45`:9_, ,v. c Go 7,0
. ,..:.,,...:7-;•1',.. bo,6414.01144 .5004 • •I4 4 4 i. , 4 b -..,...., . psou..
• 527_.2........____- , ._ ..:•!:::. ....s:,., IA'-..1/4..f/7.- ': `.." a -...t,,,....
. - .. - -`•,t, .t..- . i 'P 'eit.1 I
...%
. C Vi It.) \ • . ._ r..6_ro.nd W.fre.r •• ' •-----__I,k._...-
_ — - - -
- T _
stk,-Lon- AA----"..-".*`•—•._s 5 Sue cOiL \-VD"- Iii 5-roll E 1
.51 .
ZEptouE
REM0VE ORGANIC, MAI-SA.1AI. —7-1 -- - - I
S7/,'"/Z5.:asirr.perv.v,s Ltns
. •. . .
A
\.\\ \ . \ I 1 ' i 1 ' I ) ....4.-----~-e-i;VMPii .:. Ci-INAI-Ja•:: .
‘,...,..• \\ 1 ( !
.--.-........_'' . III
...,„..... • / .
.1 .
...___
--.
— 1 -
sEEPA3E Tir,'ENviN
,, -1
--.1—,—.1 A •
. i
g el II I
'fie "1 S7CNE 1 t • --
I i
• -- i
I
----- 1
I i
....-^,
1 .N.I.II
,,..s..
I . X
i 24' ---"..-.....
*-- " I I -•,---
In PERFORATED 1 _
P VC PIPE ..---..\1 4 5,,- c----..-4., i ,. II
' j'i i / P'
1 A i 1 . • -...-•
: . ' A
1
' A
I * ; I 1,11 ....•...
... Y ,
i ---1,
< ›...I-.c -2'7
—,..i
...
--.c --
- P,-•
1--1' ' \
•
/
____Y '1/4‹ 1 / / /
s .
•
' .
•
• .,....
..ar'+L i.r,;t` I.CliJa`J l.i:tl ciil.li t. �iYi\G iACUilt7L PkAK CUis:i J� s
)ji7/��
_>
� a
Lj �
r i��sL C t�v A-i
f tb.-91 1 r� i-U A A
1 �
The above sketch shows the locations of the units comprising your sewane disposal
system for future reference in case of difficulty. It shows measured distances
from buildings, trees, garage, fence posts, etc. , to septic tank, sewers, distri-
bution box and absorption field or seepage pits.
CONTRACTOR: John Mason DATE INSTALLED:
DESIGN BASIS
1. No. of bedrooms: 3 5. Septic tank: type concrete
2. Daily flow: gpd capacity 1500 gals.
3. Undisturbed soil depths: 6. Size of leaching device: ft.
a. To groundwater: - 2 ' 7. Type of system (conventional , fill ,
b. To impervious lens: >5,
etc. ): pressure
4. Percolation rate: min/in.
LGPC MAP NO.: APPROVED BY: DATE: