1987-349 BUILDING PERMIT
TOWN OF QUEENSBURY No. 87-349
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Sheldon Hurst
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OWNER of property located at 17 Dixon Court Street, Road or Ave.
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in the Town of Queensbury, To Construct or place a Sewage Alteration — ~
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at the above location in accordance to application together with plot plans and other information hereto filed and k
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance_ rn
1. OWNER'S Address is 17 Dixon Court
Queensbury , New York 12801
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2. CONTRACTOR or BUILDERS Name Sanitary Sewer Service o
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a CONTRACTOR or BUILDER'S Address P . 0 . Box 224 r*
Glens Falls , New York. 12801
4. ARCHITECT'S Name
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S. ARCHITECT'S Address
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B. TYPE of Construction — (Please indicate by x) o ri
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I ) Wood Frame I 1 Masonry ( I Steel I )
7. PLANS and Specifications
No. diet . box and 200 fto leach field per plot and application
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8. Proposed Use
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Sewage system for dwelling M m
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$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES June 15 19 89 r
(11 a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
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town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 15th _ �+ Day of June 19 87
SIGNED BY ')W �,� �-�' a� for the Town of Queensbury
Building and Zoning Inspector
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APPLICATION FOR SEPTIC DISPOSAL PERMIT
Juny�§ 1987
DATE a(-. AAC fr- f
BUILL>li1IG a COi7E DEP�f.
'72LOCATION OF PROPERTY FOR
IINSTALLATION
Owner's Name: Telephone:
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Address: ? � /' e7lt l Crf [-'`__
Installer's Name: �* ]t1 1 T' An CJ eLV 2 jt Telephone: �7 R
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography circle one: l .t Rolling Steep Slope % of slope
Soil Nature: circle one: an Loam Clay Other / Depth: feet
Ground Water: At what depth? feet
Bedrock or Impervious Material: At what depth? _ "'~"` feet
Percolation test: circle one<2H regr ru r required { rate min. inch.
Domestic water supply circle one< Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption ! -� feet
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PROPOSED SYSTEM * Septic Tank 000 gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S) * Number of -- { Size each feet by "' feet
Size of stone to be used it / Depth or Thickness _ I�_ feet
IMPORTANT
._.Please...LIST NEW EQUIPMENT TO BE INSTALI.Fi�
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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
Be 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 regulatious above and agree to abide by th requirements
of the Town of Queensbury Sanit a Disposa3 ce.
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Signature of re onsible 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
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�./o,wrn of Queen3l ary
BUILDING and ZONING DEPARTMENT
Bay and Hauiland Road. R. D. 1 Sox 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME s� e �tS s'JYa �7 GCk-5
AT I ON /—e a�i +� k= G h �d
(ir D jkh4 _1 & 7 PERMIT NO. 9 7 ~' 39/1
SOIL TYPE - Sand - Loam - Clay -
percolation Test Required? YES - NO
Percolation rate - Min/Inch _ �7
TYPE of SYSTEM: U
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
Sngm to tank �lJ
Tank to list . box ' /"'�'
Dist. box to field/ t _�_ J ^
openings sealed? YE NO Partial
LOCATION/SEPARATIONS : �fl J+ ' f t.
Foundation to tank !
Foundation to absorptionft -
Absorption to lot line IT'fto
Separation of pits f t.
LOCATION STEM ON PROPERTY (circle one)
Front - ear y Left si.cle - Right side
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SYSTEM USE AppROVE YES NO
Bu ding Inspector
01/86 and vl