1986-113 BUILDING PERMIT
TOWN OF QUEENSBURY No 86-113
WARREN COUNTY, NEW YORK
Charles Russell
PERMISSION is hereby granted to
OWNER of property located at Burch Road Street,Road or Ave.
Sewage Alteration c,
in the Town of Queensbury,To Construct or place a
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 255 Burch Road u
RD F3 m
Glens Falls, New York
2. CONTRACTOR or BUI LDER'S Name same
3. CONTRACTOR or BUILDER'S Adds
same to
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4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
I I Wood Frame 1 )Masonry I I Steel 1 1
7. PLANS and Specifications
1000 gallon tank, dist. box and 2 — 6'x8' drywalls
No. per plot and application submitted.
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8. Proposed Use rt
Sewage system for dwelling. m
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10.00 April 11 fg 88
$ PERMIT FEE PAID—THIS PERMIT EXPIRES
Of a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of oueensbury before the expiration date.)
Dated at the Town of Queensbury this 13 th Day of April 19 86
SIGNED BY a ,� for the Town of Queensbury
/ / I
Building and Zoning Inspector
l TOWN '-E N`^'J 'V Jorun of Queenitury O
I'L ((Il i�' 1;� �jh BUILDING and ZONING DEPARTMENT
LL _ ,l )( (Li Bay and Haviland Road, R.D. 1 BOY 98
AYH u 1986 �y,/,/� Oueensbury,New York 12801
AM. 0c -Pk!D
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SEPTIC DISPOS/AlL PERMIT APPLICATION
Owner' s Name (,\-t Lt 3 IZQ ',SQ: Ll— Tel.
Address Lc Goilc4c4 QnNfl -
- Person/Firm installing system ()//(/_-
Number of bedrooms(residential only) °„L
Total daily flow: (compute @ 150 gal.per bedroom per day)_ 'J (p C)
Topography: 41:10rolling - steep -(circle one) Decree of slope _%
Nature of soils: (sandy\\loam-clay- other- Depth ft.
//
Ground water-- at what depth? 20 .}- ft.
Bedrock ,or impervious material--at what -depth?
Percolation Test - N4lot required y )equired -Rate min/inch.
Domestic Water Supply - Municipal - - Other
IMPORTANT !
On a separate piece of paper , submit a diagram of the proposed septic
system with all dimensions; including distance from any structure, .
distance from property lines and distances from any domestic water
supply or shore-line of lake, stream, pond or wetlands. Include all
dimensions of the system itself.
Description of proposed system:
Septic tank size 00 gal.
Ti •
51.... ..f otwalw }
Seepage Pit (s) Number_ 2 / Size 6ftX- S{ ft. Size of stone@ 3
Any contractor, corporation, individual,Etc. , engaged in the
construction of a Sanitary Sewage Disposal System, who covers the
same before inspection, does not have an approved Permit, or varies
from the approved application , will be subject to a Penalty of $250
as provided for in Section 6. 010 of the Town of Queensbury Sanitary
Sewage Ordinance.
Signature of Applicant bate
01/86 and/vl
Jown of Queenshury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
Y6 -//3
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME (' n4rhec Russell
LOCATION &M h(A, i9044
DATE `/�,.R/RG, PERMIT NO. zyG - /13
SOIL TYPE - Sand - Loam - Clay -
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) J
Size- (p ft. X (4 ft.
Gravel size 3
PIPING: Size Type
Bldg. to tank
Tank to dist. box
Dist. box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank /nb ft.
Foundation to absorption 100 ft.
Absorption to lot line ,() ft.
Separation of pits yhft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COIMENTS:
SYSTEM USE APPROVED/.,C/�7 1-475-
NO
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