1986-506 BUILDING PERMIT
TOWN OF QUEENSBURY No. 86-506
WARREN COUNTY, NEW YORK
cq
PERMISSION is hereby granted to Douglas Williams
OWNER of property located ai3gjl Dixon 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 OR
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is N
194 Dixon Road
Glens Falls, New York w
U)
2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer Service
3. CONTRACTOR or BUILDER'S Address N
P. 0. Box 224
Glens Falls, New York
0
4. ARCHITECT'S Name
0
a.
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
cn
( )Wood Frame ( ) Masonry ( )Steel ( )
0
04
7. PLANS and Specifications S
No. 1000 gallon tank, 2 8'x8' seepage pits per plot and rt
application submitted.
1-1
8. Proposed Use rt
Sewage system for dwelling
$ 10.00 PERMIT FEE PAID—THIS PERMIT EXPIRES August 19 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 19th Day of August 19 86,
SIGNED BY 1I a, for the Town of Queensbury
Building and Zoning Inspector Car'
i own of QueQn,Sturl APPLICATION FOR SEPTIC DI{.-era
BUILDING and ZONING DEPARTMENT 0 AEI ' h
Bay and Havitand Road, R.D. 1 Box 98
Queensbury, New York 12801 n DATE �� / '! "' AUG 7 O Orgy.,.��g,
LOCATION OF PROPERTY FOR 'INSTALLATION ( t ( (--) l� 3t „ )20516
d
OWNER'S NAME c Cu • kJ ( I (c A- but 4`-
(� r�
ADDRESS `l / 0/0 f,U) TEL
INSTALLER' S NAME . A L� l n gum( I ��r�rC TEL7 - 70/,-
Number of bedrooms (residential only) 2
Total daily flow(compute °@ 150 gal per bedroom) 5-0
Topography: Flat - Rolling .- Steep slope - (circle one) % of slope
Soil nature: Sand ' Loam - Clay - Other Depth ft.
Groundwater -At what depth? ft.
Bed-rock or impervious material - At what depth? ft.
Percolation test - Not require)- Required - -Rate - min-inch.
Domestic water supply - Municipal - Well - Other
Separation - Watersupply(if well) from Septic absorption ft. •
Proposed System: Septic tank ./000 gal: ( Minimun size, 1000 gal. )
Tile Field - Each trench ' - ft. Total system legnth " -- ft.
Seepage pit (s) Number of ,— . Size each -le ft X '6 ft 0?>(S )�
Size of stone to be used # 3 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, strea-xn,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 a/elat
Date _e_2#1,
•
05/86 and/vl
Section II Septic System Inspections:
A. All applications for septid system installation,
alteration or repair, as required 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.
•
•
•
•
•
•
•
•
•
•
•
_awn o/ Queen3hury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
m1 �
NAME D'Ve----11 'S LU t 4 (o qat__
LOCATION (Q i X t (-it e yf -3"6 C.
DATE / W- PERMIT NO. its 7
SOIL TYPE - 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 P '384Number Ff)
Size- Kft. X -eft.
Gravel size
PIPING: Size Typell -(J
Bldg. to tank tY
Gt
Tank to dist. box -
Dist. box to field/ -
Openings sealed? ES' NO Partial
•
LOCATION/SEPARATIONS:
Foundation to tank ft.
Foundation to absorption 6, it.
Absorption to lot line /6, 1ft.
Separation of pits lb it.
LOCATION STEM ON PROPERTY(circle one)
Front •Rear - Left side - Right side -
COMMENT
SYSTEM USE APPROVED NO
Building In-.ector l
01/86 and vl
SANITARY SEWER SERVICE
LUZERNE RD. GLENS FALLS N.Y. PHONE 792-7257
1
ec
Is-47, .1
;\of
VrYa2< eu ,P 330
6 � P
a
C
f4-7
D
/ "'Oi J /tad d9D