1986-717 BUILDING PERMIT
TOWN OF QUEENSBURY No. 86-717
WARREN COUNTY, NEW YORK
PER ISSION is hereby granted to Gary Mock
23 Bonner Drive
OWNER of property located at Street, Road or Ave. 0
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.
1. OWNER'S Address is
23 Bonner Drive
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name N
Carl Dingman
Reliable Sewer Service
CD
3. CONTRACTOR or BUILDER'S Address )-1
RD #3 d
Glens Falls, New York C
0
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction— (Please indicate by X)
( 1 Wood Frame ( ) Masonry ( 1 Steel ( ) cn
rD
7. PLANS and Specifications W
aq
No. new dist. box and two 7'x8' seepage pits per plot and 'D
application submitted.
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8. Proposed Use n
Sewage system for dwelling rt
N•
0
$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES Oct. 21 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 21st Day of October 19 86
SIGNED BY `//7 2- ly / for the Town of Queensbury
Building and Zoning Inspector �:
own o Queitury
APPLICATION FOR SE�� I�G �SP�O�SAL�P�E��I�,T
BUILDING and ZONING DEPARTMENT
Bay and Haviiand Road, R.D. 1 Box 98 j_� ! ��
Oueensbury, New York 12801 DATES E Fri
. . C/ f
LOCATION OF PROPERTY FOR. 'INSTALLATION � �(//�[Xi.
OWNER'S NAME '���. C� _ �j
E n i2.��..4
ADDRESS � J 1/ TEL ?, �� /74
,�/ rYY�irtp�� CCC���-�1.
INSTALLER' S NAME %' �S� TEL 7 72 ^2 2Il
Number of bedrooms(residential only) W , . .
Total daily flow(compute @ 150 gal per bedroom) 2/ 5---
Topography: Rolling - Steep slope - (ci e one) % of slope
Soil nature: Sand - Loam - Clay - Others Depth ft.
•
Ground water -At what depth? - ft. •
Bed-rock or impervious material -. At what depth? ft.
Percolation test - Not required - Required - -Rate min-inch.
Domestic water supply - Municipal - Well - Other P
- Separation. - Watersupply(if well) from Septic absorption ft.
Proposed System: Septic tank gal. ( Minimun size, 1000 ..gal. )
Tile Field - Each trench ft. Total system legnth ft.
Seepage pit(s) Number of . Size each 7 ft X & ft
Size of stone to be used # ' "4 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, itsblf.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
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
Sanitary Sewage Disposal Ordinance.
57) '
Signature of responsible person '1(2
J_C-D,...:ca ,-,,��
Date (//�
05/86 and/vl a .
, ,_5 c to 2/ /&1�
_locun 01 ueenibur/f/cy
` i { BUILDING and ZONING DEPARTMENT
1� { Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME I v_ /,k.
LOCATION 7 f :-&t,v c_,/ b-y--
DATE /O / Z.,1 PERMIT NO. X -- 7i 7
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 �ITS4Numb9x'of)
4
Size- ft. X C71 ft.
Gravel size ' 2�
PIPING: Size Type
Bldg. to tank
Tank to dist. box VC-
Dist. box to field/p' fur
L_
Openings sealed? dip NO 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 side -
COMMENTS:
SYSTEM USE APPROVED YE NO
Bui ding Inspector
01/86 and vl
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