1986-844 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 86-844
WARREN COUNTY, NEW YORK
W6 I 1 �
PERMISSION is hereby granted to Stan Kosinski
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OWNER of property located at \ SO
Aviation Road Street, Road or Ave.
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in the Town of Queensbury,To Construct or place a Sewage Alteration o
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 226 Aviation Road
Queensbury, NY 12801
2. CONTRACTOR or BUI LDER'S Name
Sanitary Sewer Service C
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3. CONTRACTOR or BUILDER'S Address 0
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P. 0.Box 224
Glens Falls, New York
4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction— (Please indicate by X) tv
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( ) Wood Frame ( ) Masonry ( ) Steel ( )
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7. PLANS and Specifications
No. new 1000 gallon septic tank per plot and application o
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8. Proposed Use
Sewage system for dwelling
$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES Dec. 10 1988
(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 December 19 86
SIGNED BY - for the Town of Queensbury
Building and Zoning Inspector C
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Queenilury APPLICATION •FOR SEPTI = ;D� °�OSAL�'PERMIT';
BUILDING and ZONING DEPARTMENT 1) � l ( a (� \\.a7 i 1 -)
Bay and Haviland Road. R.D. 1 .Box 98 ii _ ,i S
Ca p.9 .40
ensbur-y, New Yon 1280! DATE , 1 /s '° -tF(��: 4 r-.,r;l.N
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LOCATION OF PROPERTY FOR INSTALLATION
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OWNER' S NAME kC_Dgi,j-__C-k -7 � ~
ADDRESS C2 (2 (.3.
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Ll,s✓ 7_0/4L7D TE.L:794`O (p //
INSTALLER' S NAME P9 /0
/ O('L[J f&"Lent, TEL 7.? -7,2 3-7
Number of bedrooms (residential Lily) tg
To 'al daily flow(compute @ 150 gal per bedroom) g: 4
Topography: Fla - Rolling - Steep slope - (circle one) % of slope.
Soil nature: Sand - Loam - Clay - Other Depth ft.
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Ground' water -At what depth? ft.
Bed-rock or impervious material - At what depth? ft...
Percolation test - Not required - Required, - -Rate min-inch.
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Domestic water supply Municipa j- Well - Other
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Separation - Watersupply(if well) from Septic absorption ft,
Proposed System: Septic tank /0 O D 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 bOMESTIC 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
Sanitary Sewage Disposal Ordinance . 1 •
Signature of r sponsible person 120).1 ;(1 - f
05/86 and/vl •
Section II Septic System Inspections:
A. •All ' applications for septic system installation,
alteration or repair, as required by the Town of
Oueensbury Sanitary Sewage Ordinance, shall be
submitted to the Buildina Department at least
24 hours before start of construction and shall
include .a ":plot plan showing:
1) the proposed location. vf 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 he
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 Oueensbury Building '.
Department before further construction.
_town 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 ke 5/4)'5k /
LOCATION /�L VjAj®PU
DATE L/ 7 /867PERMIT NO. g(p- g
SOIL TYPE -r -and Loam - Clay -
Percolation Required? YES - 0.�
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: Size Type
Bldg. to tank
Tank to dist. box _
Dist. box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank ,19.Q ft.
Foundation to absorption fj���
Absorption to lot line ft �/��i
Separation of pits ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front - Rear - Left side - Right side -
COMMENTS: ?a-gAil
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SYSTEM USE APPROVED NO
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Building Inspector
01/86 and vl
---- ----- SANITARY SEWER SERVICE
LUZERNE RD. GLENS FALLS N.Y. PHONE 792-7257
de ..S'e IN Lio ,
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