87-203 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 87-203
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Dennis MacElroy
OWNER of property located at end of Knox road, Assembly Point 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 RR #1 Box 1246
Lake George, New York
2. CONTRACTOR or BUILDER'S Name
same fD
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3. CONTRACTOR or BUILDER'S Address
same
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction— (Please indicate by X)
( ) Wood Frame ( ) Masonry ( )Steel (
7. PLANS and Specifications
300 gallon steel septic tank per plot and application
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8. Proposed Use
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Sewage system for dwelling
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10.00 April 27 89
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19 rt
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
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town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 27th Day of April 19 87
SIGNED BY r 11 for the Town of Queensbury
Building and Zoning Inspector �.
TOWN OF QUEr NSE-1,-'
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APPLICATION FOR SEPTIC DISPOSAL PERMIT AF 2 1997
BUILDING & CODE DEPT.
DATE Apii1L 1 / "Y
LOCATION OF PROPERTY FOR INSTALLATION
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Owner's Name: 1,1� v f_k;C,�ua cr-,i Telephone: 5
Address: `21 _"'- � = k-a,41 G LA YC� -` 1,4
Installer's Name: Telephone:
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one: 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: Municipal Well Other LAKE- C'-LEOca.c.d
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption — feet
PROPOSED SYSTEM: Septic Tank 36p gal. (minim-um-si-ze:- 110.00-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
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
LL' T L ` 1-1 C-77 tact‹.
(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 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 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 $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 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 Sanitary Sewage Disposal Ordinance.
Signature of responsible person:
Date:
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
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Jocun o f Queenitury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION '
NAME ,41:2 e-7) y'
LOCATION Ai((DK' t'�D MSG-A? PP-
DATE -A- / 87 PERMIT NO. 847 - �O3
SOIL TYPE `- Sand -(foam Clay -
Percolation Test Required? YES -63)
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 V
Dist. box to field/pit b,'
Openings sealed? sES ' NO Partial
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LOCATION/SEPARATIONS:
Foundation to tank /Oft. `f-
Foundation to absorption ? ft.
Absorption to lot line P ft.
Separation of pits Jr ft.
LOCATION OF SYSTE ON ”OPERTY.(circle one)
Front - Rea —Left side Right side -
COMMENTS:
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SYSTEM USE APPROVED 40111 NO
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Bui`1 'ng Inspector
01/86 and vl