1986-136 BUILDING PERMIT
TOWN OF QUEENSBURY No 86-136
"1 /1 5gREN COUNTY, NEW YORK
PERMISSION is hereby granted to James Havens
OWNER of property located at 16 River St. (West Glens Falls) 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
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNERS Address is 16 River St.
Queensbury, NY 12801
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2. CONTRACTOR or BUILDERS Name Condon's Septic and Drain Service
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3. CONTRACTOR or BUILDERS Address
17 Grant Ave.
Glens Falls, New York
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4. ARCHITECT'S Name mn
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5. ARCHITECTS Address
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6. TYPE of Construction—(Please indicate by X) 0
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( )Wood Frame I I Masonry I 1 Steel 1 1 r
in7. PLANS and Specifications in
1000 gallon tank, dist. box and 1 6'x8' drywell with #3 stone
No. per plot and application submitted. ro
B. Proposed Use pegm
Sewage system for dwelling co
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$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 21 19 88 0
IIf 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 y�21st Day of April 19 86
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SIGNED BY '/adi a . /0.kC1rK/ for the Town of Queensbury
Building and Zoning Inspector
flown of Queenetury IC\4 L�
BUILDING and ZONING DEPARTMENT Rig .
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Bay and Haviland Road. R.D. 1 Boa 98
p40.19Oueensbury, New York 12801 Pik
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/�DISPPOSAL PERMIT APPLICATION'
Owner ' s Name
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Address lb AiV€6Z. Sr Q11pErvs'do by /I/`, / 1-8°/!'
Person/Firm installing systemCOniDo,vs ce,.01fL- w Drain) SiA
Number of bedrooms (residential only) oZ
Total daily flow: (compute @ 150 gal.per bedroom per day) 30& 64/-
Topography: rolling - steep - (circle one) Degree of slope _P
Nature of soils: sanoam-clay- other- Depth 3 , ft.
Ground water-- at what depth? ( e, ' '-- ft.
Bedrock or impervious material--at what depth? FilowiCft. -
Percolation Test -(Not required / Required -Rate min/inch.
Domestic Water Supply - Municipal - Well - 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 mix 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 000 gal .
Tile field- Length of each trench__ft. Total field ft.
Size of stone # •
Seepage Pit(s) Number / / Size 6 ftX a ft. Size of stone* 3
Any contractor, corporation, individual, Ete. , 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 pplicant Date
01/86 and/vl A(aw /a o6 to--, K
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Septic System Inspections:
A. All applications for septic system installation ,
alteration or repair, as required by the Town of
Oueensbury Sanitary Sewage Ordinance, shall be
submitted to the Buildina 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 Oueensbury Building
Department before further construction.
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flown of Queensbursi
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road. R.D. 1 Box 98
Oueensbury. New York 12801
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SEPTIC DISPOSAL SYSTEM INSPECTION
NAME1.
LOCATION/
DATE 4 PS& PERMIT
SOIL TYPEdalt - Loam - Clay -
Percolation est Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches
Size of graver_
SEEPAGEIPITS{Numbe of)
Size- ft. X ft. ._----
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box _
Dist. box to field//F't NO partial
Openings sealed? GP
LOCATION/SEPARATIONS:
Foundation to tank jQft.
Foundation to absorption
Absorption to lot line VD ft.
Separation of pits
LOCATIO alk ROPERTY(circle one)
Front _ - Right side COMMENTS.
SYSTEM USE APPROVED 40NO
Building Inspector
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