1986-551 BUILDING PERMIT
TOWN OF QUEENSBURY 86-551
No.
WARREN COUNTY, NEW YORK
. 13 �1 �
7 0PE3oct
SSION is hereby granted to Kim Knoblock
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0
OWNER of property located at /IDConnecticut Ave. Street, Road or Ave. ce
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in the Town of Queensbury,To Construct or place a Sewage Alteration W
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.
1. OWNER'S Address is
Old Stone Schoolhouse Road
Fort Ann, New York
2. CONTRACTOR or BUILDER'S Name
Queensbury Sewer
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3. CONTRACTOR or BUILDER'S Address 0
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RD #1 0
Lake George, New York n
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4. ARCHITECT'S Name 0
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( I
7. PLANS and Specifications Cl)
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1000 gallon tank, dist. box and 110 ft. leach field per plot and w
No. application submitted. m
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8. Proposed Use H
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Sewage system for commercial building n
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$ 88
10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES Sept. 10 19
(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 10th Day of Sept. 19 86
SIGNED BY Cam! L /0 for the Town of Queensbury
Building and Zoning Inspect r
TOWN OF QUEENSBURY
• -, BUILDING S BONING DEPARTMENT
•
SEWAGE DISPOSAL PERMIT APPLICATIONS N OF QU -ENS I ;'
1. Owner's Name V:i _ vi 0 (�, fo L - E 0 lJ V k I� '�i
V---4/c1/6-4Address ��_ Sil
AN 2 Q 1986
P �'-e-` l°67 P.M.a hon I ipmi-1131211 516
` 2. • Property location (i yi n , a 0 F
3 . Name of person or firm responsible for installing system
Ca.4_up0.41 S�� „/,�-s�,,- Telephone No. 7 V 56 ,
Address 75cr-4 (,, . A6t.4 /r
. e__,7 ,..e..._____
4. Number of beLrooms (residential buildings only) ZC.,
5. Daily flow' 45.-D pt. gallons/day
6. Septic tank capacity A01-7-7.) gallons
7. Topography: rolling, steep
% of slope -
8. Nature of soil and depth ,-;; ,-----3,j •
9. ' If ground water, bedrock or im ervioulmaterial is appar
ent at what
depth does it begin? - ft.
10. Percolation test: A is required
B is not required
C If required what is the rate - minutes/inch
11. Water supply: municipal, well, other
12. Type of system proposed: drywell, - other /f.,k b�
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
Queensbury Sanitary Sewage Ordinance. „....,
Date j / �� _
h` si atu e 'o a licant
On separate sheet of paper submit a diagram of the proposed septic system
with all dimensions, including distance from any structure, distance from
property line and domestic water supply, etc. Include all dimensions of
the system itself.
Form 3-82
i
Jown of Queenitury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
rl Queensbury, New York 12801
4/4
lD SEPTIC DISPOSAL SYSTEM INSPECTION
$4,..c.A?NAME ,/c/�,
LOCATION( J (, Ce,ve—
DATE i /( PERMIT NO. (56 -SSA
SOIL TYPE S n - Loam - Clay -
Percolation est Required? YES NO
Percolation rate - Min/Inch
TYPE of SYSTEM: i
Absorption field, total length 00
Length of each trench 'D t r-},i-ee TO
Depth of trenches pi /
Size of gravel :4-� ,,------
SEEPAGE PITS{Number of) (
Size- ft. X ft.
Gravel size ' - ��
PIPING: Size Type
Bldg. to tank t/" VO
Tank to dist. box _
Dist. box to field/p t
Openings sealed? tS NO Partial
LOCATION/SEPARATIONS:
Foundation to tank /0 ft.
Foundation to absorption 0-E2ft.
Absorption to lot line /p ft.
Separation of pits ft.
LOCATION OF SYSTE .-.-9 PROPERTY(circle one)
Front - Rear - L ft sid - Right side -
COMMENTS:
SYSTEM USE APPROVED Ii NO
Building Inspector
01/86 and vl
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