1986-186 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 86-186
�U WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Frederick D. Jackson
OWNER of property located at 61 Country Club Road
Street,Road or Ave.
in the Town of Oueensbury,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.
I. OWNERS Address is 61 Country Club Road m
Glens Falls, New York p.
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2. CONTRACTOR or BUILDERS Name
Hometown Sewer
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3. CONTRACTOR or BUILDERS Address
Warrensburg, N.Y. °y
4. ARCHITECTS Name
5. ARCHITECTS Address
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6. TYPE of Construction—(Please indicate by XI
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1 1 Wood Frame 1 1 Masonry 1 I Steel I I 'C
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T. PLANS and Specifications
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No 1000 gallon septic tank, dist. box and 180 ft. tile field per
plot and application submitted.
8. Proposed Use
Sewage system for dwelling
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$ 10.00 PERMIT FEE PAID -THIS PERMIT EXPIRES May 5 88 co
19 m
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the m town of Dueanabury before the expiration date.)
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Dated at the Town of Queensbury this 5th Day of May 19 86 n
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Q.SIGNED BY n for the Town of Oueensbury o
0 Building and Zoning Inspectorr
Jown of Queend6ury TOWN of �;.� :: -•
BUILDING and ZONING DEPARTMENT �� r
Bay and Haviland Road. R.D. 1 Box 98
Oueensbury, New York 12801 &I 1)1
7181p0-1"--(i;& (IAI4
'111:1:.=;j L13I4I5I8
SEPTIC DISPOSAL PERMIT APPLICATION
•
Owner 's Name �5ct5 ,p) c c 1`s o R Tel
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Address / Cnora my (34i „ 44' � l= /'<' /z ��f l/
/ /Person/Firm installing system �6, t'" �ivf/ i`= /i-/=,E;
Number of bedrooms (residential only)
Total daily flow: (compute @ 150 gal.per bedroom per day) .' 00
Topography: flat -(rolling_..)- steep -(circle one) Degree of slope /0 %
Nature of soils: sand-loam clay ' other- Depth 1y,^/, ft.
• Ground water-- at what depth? / ft.
Bedrock or impervious material--at what depth? 0 4- ft.
Percolation Test - Not required 71 Required -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.
Descriptia of proposed system:
Septic tank size ,sew gal.
Tile field- Lenq'th of each trench 60 ft. Total field/p-0 ft.
Size of stone # _2--
Seepage Pit (s) Number / Size ftx ft. Size of stone#
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.
g nature o pli can t ��//g��
Date/
01/86 and/vl '
Septic System Inspections:
A. All applicationg for septic system installation,
alteration or repair, as reauired by the Town of
pueensbury 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 dryweli=e
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 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 Building
Department before further construction .
_/own of Queenlbury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
3 NAME ACICS01.1
LOCATION atATCYL4 CLue 12o.M
DATE S/7 / KL PERMIT NO. O t -- / 6 (Y
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch -
TYPE of SYSTEM: V
Absorption field, total length O
Length of each trench 40- 50 - '70
Depth of trenches - 2 4 4
Size of graSel
SEEPAGE PIT er of)
Size- ft. X ft
Gravel size —�
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 rS'ft.
Foundation to absorption _ zO ftANSLk1b
Absorption to lot line Zo ft.t-
Separation of-pit,, _ft
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - cis- Left side - Right side -
CCMMENTS:
SYSTEM USE APPROVED NO
Buil ing Inspect r
01/86 and vl
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