1986-467 BUILDING PERMIT
TOWN OF QUEENSBURY 86-467
No.
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Helen Cowan
OWNER of property located at .11 Cleverdale 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 Cleverdale, NY
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2. CONTRACTOR or BUILDER'S Name
Sunsoval, Inc.
3. CONTRACTOR or BUILDER'S Address
Cleverdale, NY
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. 1000 gallon tank — existing 1000 gallon septic tank to be used
— with seepage bed per plot and application submitted.
8. Proposed Use
Sewage system for dwelling
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$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES August 7 19 88
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the rt
town of Queensbury before the expiration date.) cD
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Dated at the Town of Queensbury this 7th Day of August 19 86 0'
SIGNED BY Ad a.. k'ai for the Town of Queensbury
Building and Zoning Inspector (I1
gown of QueeniLry APPLICATION FOR SEPTIC 74'(� QF R
BUILDING and ZONING DEPARTMENT V E
Bay and Haviland Road, R.D. 1 Box 98 �+
Queensbury, New York 12801 j DATE 8 / 1 AUG I 1986
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LOCATION OF PROPERTY FOR INSTALLATION
OWNER' S NAME Mrs . Helen Cowan
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ADDRESS Main Road, Cleverdale, Nuw York 12820 TEL 656-9441
INSTALLER ' S NAME Sunsoval, Inc. TEL 656-9956
Number of bedrooms (residential only) 3
Total daily flow(compute @ 150 gal per bedroom) 450 •
Topography: Flat - Rolling - 'Steep slope - (circle one) % of slope
Soil nature: Sand - Loam - Clay - Other clay loam Depth 4 ft.
Ground water -At what depth? over 4 ft.
Bed-rock or impervious material At what depth? over 10 ft-
Percolation test - Not required - Required - -Rate - min-inch.
Domestic water supply - Municipal - Well - Other lake
Separation - Watersupply(if well) from Septic absorption over 100 ft-
Proposed System: Septic tank 1000 gal . ( Minimun size, 1000 gal. )
Tile Field - Each trench _ ft. Total system legnth - ft.
Seepage pit(s) Number of - . Size each ft X _ ft
Size of stone to be used # - Depth or thickness _ 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, stream, 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 aZZ requirements of The Town of Queensbury
S_zu . , try Sewage Disposal C '1nan. .. _ .
Signature of responsible person — -
Date 8/1/86 _ r L
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Jown of Queeniurty
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION
DATE / �'�PERMIT NO.
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)
Size- ft. X ft.
Gravel size
PIPING: S ze /Type
Bldg. to tank
Tank to dist. box
Dist. box to field/pit
Openings sealed? YES O Partial
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption ft.
Absorption to lot line ft.
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right sid -
COMMENTS:
SYSTEM USE APPROVED YE NO
Buildii\g Ins 'ector
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L LOCATION SKETCH A
A 5 .I. OF LABAR. I
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04000 GAG-- C-0NcR61E PUMP TANK (EwsTMMMG)
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DESIGN BASIS
1 . No . of bedrooms 3
2 . Daily flow 450 gpd
3 . Septic tank capacity 1000 gals .
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4 . Percolation rate - min/in.
5 . Length of absorption field ft .
_ NAME: Mrs . Helen Cowan •
DATE: August 1 , 1986
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The above sketch shows the locations of the units comprising
your sewage disposal system for future reference , in case of
difficulty. It shows measured distances from buildings ,
trees , garage , fence posts , etc. , to septic tank, sewers ,
distribution box and absorption field or seepage pits .
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