1986-257 BUILDING PERMIT
TOWN OF QUEENSBURY No 86-257
WARREN COUNTY, NEW YORK
f I �I dt �� ( Francis Bly
PERMISSION is hereby granted to
OWNER of property located at 12 River St. Street, Road or Ave.
(West Glens Falls)
in the Town of Queensbury,To Construct or place a Sewage Alteration n
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. N.
1. OWNER'S Address is
12 River St. Cv
Glens Falls, New York
2. CONTRACTOR or BUI LDE R5 Name
Sanitary Sewage Service
N
3. CONTRACTOR or BUILDER'S Address ,m
P. 0. Box 224
Glens Falls, New York
N
4. ARCHITECT'S Name nt
5. ARCHITECTS Address
6. TYPE of Construction—(Please Indicate by XI
( 1 Wood Frame ( 1 Masonry ( )Steel ( 1
to
m
T. PLANS and Specifications
No.
1 — 6'x8t drywell 24" #3 stone per plot and application
B. Proposed Use
Sewage system for dwelling p'
N
0
$ 10.00 PERMIT FEE PAID—THIS PERMIT EXPIRES May 23 19 88
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of UueensbuN before the expiration date.)
Dated at the Town of Queensbury this 23rd Day of
of/1 May 19 86
SIGNED BY '✓_'_ a. oD for the Town of Queensbury
Building and Zoning Inspector
c7 c
� awn of Queenllury ���/
BUILDING and ZONING DEPARTMENf,�OWN OF QUEENSBURY
Bay end Haviland Road, R.D. 1 Box 3�/ E 0 I V E n I
Queensbury. New York 12801 jlJ J
MA{ Z 2 1986 a./ f
Ally ,,iiiA rm.
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/�SEPTIC DISPOSAL PERMIT APPLIC n l C�
Owner' s Name r2r-ri(./ (� / ,r 6(V/ Tel. 79d ' 7 �Ly
Address / 2-- R/ ,/O,L 5it. (Xv Cc.ti+S b/oti4 /'
Person/Firm installing system V 6J ,o , FA (7 J PU c,- / c/«/, c
Number of bedrooms (residential only) "—
Total daily flow: (compute @ 150 aal.per bedroom per day)_ j 0 O
Topographv: flat - rolling - steep - (circle one) Degree of slope _F
Nature of soils: I loam-clay- other- Depth /0 ft.
Ground water-- at what depth? i ft.
Bedrock or impervious material--at what depth? ' ft.
Percolation Test - Not required / Required -Rate ✓ min/inch.
Domestic Water Supply f •. W- 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 aj 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 9
Seepage Pit (s) Number / / Size 6, ftX_ , -ft. Size of stonet 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. / _ / 'A U , au/ wtLC
112SVcant
3Date
01/86 and/vl
Septic System Inspections:
A. All applications for septic system installation,
alteration or repair, as reauired 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 4250.00.
C. An approved copy of the plot plan shall he
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 Buildina
Department before further construction.
C7 //
Jown 4 QUeendbury
BUILDING and ZONING DEPART Box
MnENTT8
Bay and Haviland Road, R.D.
Dueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
n l RkuoS�
NAME �-
S 1 1 LOCATION cll.— oZ.S'
DATE S /3k PERMIT NO•��—
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM: total length
Absorption field,
Length of each trench —_
Depth of trenches--
Size of gravel_
SEEPAGE PITS4N7rmber of)
Size-
ft. X
Gravel size Size Type
PIPING:
Bldg. to tank —�
Tank to dist. box
Dist. box to field/pit Partial
Openings sealed? YES NO
LOCATION/SEPARATIONS: ft.
Foundation to tank ft.
Foundation to absorption ---ft.
Absorption to lot line —ft.
Separation of pits TEM ON pROPERTY(circle one)
Fr ontt - ea -Y n - Right side -
Fr - Left side
calMENTS:
q �
SYSTEM USE APPROVED YES
g 'lding Insp ctor
01/86 and vl
SANITARY SEWER SERVICE
LUZERNE RD. GLENS FALLS N.Y. PHONE 792-7257
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