1986-873 BUILDING PERMIT
TOWN OF QUEENSBURY No 86-873
WARREN COUNTY, NEW YORK
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PE ISSION is herebyrapt d g e to Lila McCoy
OWNER of property located at 54 Blvd. 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
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is 54 Blvd.
Queensbury, NY 12801
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2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer Service
3. CONTRACTOR or BUILDER'S Address
P. 0. Box 224 u,
Glens Falls, New York
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. 250 ft. leach field per plot and application submitted. rt
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8. Proposed Use
Sewage system for dwelling
10.00 PERMIT FEE PAID—THIS PERMIT EXPIRES Dec. 26 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 26th Day of Dec. 19 86
SIGNED BY 0„031,2� 1 for the Town of Queensbury
Building and Zoning Inspecto ,
c'7 TOWN O Q NSSYRY
focus, o� Queenituru
e APPLICATI..ON FOR SEPTIC I = . Aid, PERMIT '- �: .
BUILDING and ZONING DEPARTMENTi L J t� L
Bay and Haviland Road, R.D. 1 Box 98 0.-ar-P 1.
. -':-Queensb.)r .New York 12801 -- - ,, A- -- ....c. Of '22. 1 4
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----- LOCATION OF PROPERTY FOR INSTALLATION a UU� �t/4f� °' °� °� °�1 � � �a
OWNER' S NAME A__-/ ---r4 i�i
. ea j- . - : - . -
ADDRESS t c7 • b
GI ( ev,fe /v TEL
INSTALLER' S NAME k - 1- ( ' the Sefe ! c TEL 79) - 701,5
Number o_ f bedroome(residential only). `3
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250
Total daily flow(compute @ .150 gal per bedroom)
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Topography: ' • Rolling - Steep slope - (circle one) % of slope
Soil nature: Sand - Loam -- Clay - Other Depth ft.
Ground water -At what depth? • ---- ft.
Bed-rock or impervious material - At what depth-? ft.
Percolation test �ot required - Required - -Rate min-inch. •
Domestic water supply - `Municipal - Well - Other
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Separation - Watersupply(if well) from Septic absorption ---7- ft.
Proposed System: Septic tank � YcP%�� ( Minimun size, .1000 gal..) /'
Tile Field - Each trench (5-2) ft. Total system legnth 5 U ft. -tZee�
Seepage pit(s) Number of s . Size each. --ft X — ft
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Size of stone to be used r O Depth or thickness . 'J ft.
* is * * * * is * * * * * * * * * * * * * * * * * * * * * * * * * * '* * * *
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, itself . •
* * * * * * * * * * * * * * * * * * * * * * * * * *' * * * .* * * * * * *
1 have read. the regulations on the reverse side of this sheet and agree
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to abide by - these and all requirements- of The Town of Queensbury -
Sanitary ' Sewage Disposal Ordinance .
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Signature of responsible person - a / .
. L,.: ,
05/86 and/vl
Alecd- ��� � edf1e-
Section II Septic System Inspections:
A. All applicationd for septid system installation,
alteration or repair, as required by the Town of
pueensbury 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 of the system
_ _ 2) location -and distance to lot lines
-31"`3ocat on :and -distance -to tructures .
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4) location and distance :to .any watersupply
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 iinstaller 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
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_Down o/ Quceniur y
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTIO
NAME C > C
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LOCATION
DATE if/d 0 PERMIT NO.
SOIL TYPE li- •. - Loam - Cl �-
Percolation est Required? ( S) 40,
Percolation rate - Min/Inch-- b 5
11;'\7 TYPE of SYSTEM:
Absorption field, total length 25 D
Length of each trench ,Spl
Depth of trenches at
Size of gravel lit"
SEEPAGE PITS{Number of)
Size- ft. X ft.
Gravel size
PIPING: Size Type
Bldg. to tank go 't0
Tank to dist. box
Dist. box to field/.it
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS:
Foundation to tank 0 ft.
Foundation to absorption 3C-ft.
Absorption to lot line 15 ft.
Separation of- pits ft.
LOCATION a SYSTEM ON PROPERTY(circle one)
Front g Left side - Right side -
COMMEN
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SYSTEM USE APPROVED�YES NO
644/0
Bui_ding Inspector
01/86 and vl
., SANITARY SEWER SERVICE
LUZERNE RD. GLENS FALLS N.Y. PHONE 792-725 •
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