1986-865 BUILDING PERMIT
TOWN OF QUEENSBURY No. 86-865
Q f WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to ' Lloyd Passno
OWNER of property located at Bay Road Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Sewage Alteration 0
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. ''y
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1. OWNER'S Address is RD it/
Glens Falls, New York -
2. CONTRACTOR or BUILDER'S Name
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3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) 9
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( )Wood Frame ( ) Masonry ( )Steel ( )
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7. PLANS and Specifications H.
1000 gallon tank, 2 6'x8' seepage pits with #3 stone
No. per plot and application submitted.
8. Proposed Use
Sewage Alteration
$ 10.00 PERMIT FEE PAID—THIS PERMIT EXPIRES July 1 19 87
(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 December 19 86
/SIGNED BY 7 d• /"Q,R�••� for the Town of Queensbury
Building and Zoning Inspector g
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TOWN OF N 1W
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APPLICATION FOR SEPTIC DISPOSAL PERMIT t l,,,,, f 49 L U 4 6=
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DATE /2-/ $' I
LOCATION OF PROPERTY FOR INSTALLATION - 297 d,
Owner's Name: S Telephone: 7?,3—S y3
Address: _ RD ' / Pj'_n,r 4c7 , cj ././I
Installer's Name: Telephone:
Number of bedrooms (residential only) __
Total daily flow (compute @ 150 gal per bedroom) 7
Topography: circle one: la Rolling Steep Slope % of slope
Soil Nature: circle one: and Loam Clay Other / Depth: _ feet
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Ground Water: At what depth? . feet
Bedrock or Impervious Material: At what depth? /.) feet
Percolation test: circle one: not required required / rate min. inch.
Domestic water supply: circle one: Municipal DOther
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM: Septic Tank A v r) gal. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S): Number of 9 / Size each 6 feet by " feet
Size of stone to be used # _ �� / Depth or Thickness _ L. feet
* * * * * * * * * * * * * * * * * * * *,* * * * * * * * * * * * * * * * * * * * *
IMPORTANT
....Please...LIST NEW EQUIPMENT TO BE INSTALLED
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
(over)
Section II Septic System Inspections:
A. All applications for septic 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.
I have read the regulations above and agree to abide by these and all requirements
of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person:
Date:
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . . . A GOOD.PLACE TO LIVE
Jown of Queeniur1
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801 _
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME \ � �
LOCATION ,A k
DATEI" y /8 PERMIT NO. 5 - V 5
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: Size Type
Bldg. to tank
Tank to dist. box _
Dist. box to field/pit
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 SYSTE ON PROPERTY(circle one)
Front -CO - 0 side - Right side -
COMMENT
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SYSTEM USE APPROVED NO
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Build ng Inspector
01/86 and vl
awn o/ Queeni‘ury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Oueensbury, New/ York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME 6009 i ) 124-5S AIO
LOCATION 1&.44 am
DATE I/Iq/ 2 PERMIT NO. (y 6 -
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: Size Type
Bldg. to tank G/
Tank to dist. box
Dist. box to field/pit
Openings sealed? YES 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:
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SYSTEM USE APPROVED YES NO
Building Inspector
01/86 and vl
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BCALE:
DATE.
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APPROVED BY
DRAWN BY
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DRAWING NUMBER