1986-383 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 86-383
C + WARREN COUNTY, NEW YORK
� �
Thomas Clum
PERMISSION is hereby granted to
OWNER of property located at Luzerne Road 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.
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1. OWNER'S Address is RR #4 Box 323 co
LUzerne Road
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
Bill Threw
3. CONTRACTOR or BUILDER'S Address
RD #4
Glens Falls, New York
4. ARCHITECT'S Name N
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( ) cn
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7. PLANS and Specifications fD
No.
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8. Proposed Use
1000 gallon tank, dist. box and 2 7Tx8T seepage pits per o
plot and application submitted.
$ 1 n.nn PERMIT FEE PAID—THIS PERMIT EXPIRES July 8 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 Queensbury before the expiration date.)
Dated at the Town of Queensbury this 8th Day of July 19 86
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector j'
•
awn of Queenslury APPLICATION FOR, gPTIc DISPOSAL .PERMIT
BU►LDING and ZONING DEPARTMENT OWN o.F7' UE cptur.?Y
Bay and Haviland Road, R.D. 1 Box 98 ; 0
• Oueensbur Nev York 12801 �� � '� �/
y' DATE `) ni1.� '. ;•SI'o 6 i
LOCATION OF PROPERTY FOR INSTALLATION LtZ�U,ut CkfitA3l11 NitS1986
f�GJ:0SS 4-o- �r
Ok'NER' S NAME
` �,�1;/'� ��1����2[;3I4:{_�i�:
C61 --\&A,
ADDRESS \)6) "I gOx >.<3 L1e Z V��2 I�2vS `{'C 1A.5. TEL-67 .— In-9'
INSTALLER' S NAME � � �ecj TEL-7q' 75I
Number of bedrooms (residential only)
Total daily flow(compute @ 150 gal per bedroom) 21-572,
Topography: Flat - Rolling .- Steep slope - (circle one) % of slope rl o T
Soil nature: (San_1/-- Loam - 'Clay Other Depth ft.
. Ground' water -At "what depth? AYr— ft.
- Bed-'rock or impervious material - At what depth? • /i`--/A- ft.
Percolation test - Not required .- Required - -Rate min-inch. .
Domestic water supply - Municipal - Well - Other •
Separation - Watersupply(if well) from Septic absorption /U ft.
Proposed System: Septic tank ) 270 gala( Minimun size, 1000 gal. )
.
Tile Field - Each trench AJA-ft. Total system legnth • ft.
Seepage pit(s) Number of `z. Size each (; ft X ft
Size of stone to be used # ; Depth or thickness- AM- ft.
IMPORTANT! !
On a separate piece of paper, submit a diagram of the proposed system
with all dimensions shown; including distance from any structure,
distance from property lines and from ANY DOMESTIC WATER SUPPLY or
shore-line of lake, streazn,pond or wet-lands. Include all dimensions of
the system, itself .
* * * * * * * * * * * * * * * * * * * * * * * * * * * *. * * * * * * *. *. *
I have read the regulations on the reverse side of this sheet and agree
to abide by these and all requirements of• The Town of Queensbury
Sanitary Sewage Disposal Ordinance. •
Signature of responsible person
05/86 and/vl
Section II Septic System Inspections:
• A. All applications for septic system installation,
alteration or repair, as reauired 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.
_Jouin o f Queeniur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME C LciPi
LOCATION LV Z G'f'Cniir-/
DATE 773 / g PERMIT NO. po. - 383
SOIL TYPE - Sand - Loam - Clay -
Percolation - 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)
Size- 31 ft. X ft.
Gravel size
PIPING: Size Type
Bldg. to tank
Tank to dist. box PC,
Dist. box to field/ C—
Openings sealed? YES NO �l Partial
LOCATION/SEPARATIONS:
Foundation to tank /0 ft.(—
Foundation to absorption 7h ft. f_.
Absorption to lot line /b ft.._
Separation of pits Zj ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS:
JUQ� C d A/V/L
AST-- 0
_ ; V S2— - s
SYSTEM USE APPROVED Y NO
Bui ding Inspect r
01/86 and vl
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