96-423 BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 96423
TAX MAP NO. 27 . -1-20
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to PALMER, JAMES & MARION
1589 RIDGE RD. Street, Road or Ave.
OWNER of property located at
in the Town of Queensbury,To Construct or place a SEPTIC 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
STAR ROUTE RIDGE RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
MARCILLE, RICHARD
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
I I Wood Frame ( I Masonry ( )Steel ( 1
7. PLANS and Specifications
SEP7IbC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 98
PERMIT FEE PAID -THIS PERMIT EXPIRES July 12 19
(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.)
12 July 19
Dated at the Town of Queensbury this Da f
SIGNED BY for the Town of Queensbury
Building and Zoning I spector
Application for SEPTIC DISPOSAL PERMIT o
• STAMP RECEIVED
V1?1)
Z
Location of property fur installation: I Sq' d9c , Rd tag 1--) O
Owner's Name JRmi E PA-L. m - PERMIT NUMBER xA -dQ t0
� rarr. 01 Owner's Mailing Address: � 591 � Le �{Eal�� 6 i4 �j 01
Q� FEE PAID C`7`,cJ' '"
Installer's Name: ,�(C id AID Yet le Phone #:
1 tO
NUM her of bedrooms (if residential): Pi
2
Total daily flow (residential -compute w 150 gal. per hcdroom):
3OO'
Topography: IR-]Flat I I Rolling ( I Steep Slope % of Slope
Soil Nature: I Sand [1 Loam 11 Clay Other -/Depth:
Ground Water: at what depth? ) feet
Bedrock or Impervious Material: at what depth? 0 feet
Percolation lest: I 1 Not Required I I Required/Rate min. per inch
Domestic Water Supply: I I Municipal [J Well (----1 Other
If domestic water supply is a WELL: water supply from any septic absorption is feet
PROI'OSEi) SYS 1 M:
Septic tank: 02100 gal, (minimum size: 1,000 gal.)
'tile Field: each trench 47/ feet. / total system length /a�5.- feet.
Seepage I'it(s): number of / size each: ft. x ft.
Size of stone to he used: # / depth or thickness 1 feet.
HOLDING TANK SYSTEM: (if required)
Number of tanks: • Size of each: gal. ,
IllaTh Alarm system and associated electrical work to be inspected by a certified agency.
1'or your protection, please note that pursuant to Section 136-29 of the Code (lithe Town of
Queenshury, any permit or approi'al granted which is based upon or is granted in reliance upon
any material misrepresentation or failure to make ct material fact or circumstance knon'n by or on
behalf of an applicant, shall be void.
I have read the regulations with respect to this application and agree to abide by these and all
requirements of the Town of Queensbury .Sanitary Se 'e�j / GDiissposal Ordinance. �j
Signature of responsih'e person: i�s/2 Date: ' --- 6
TOM OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 't'/Ae-s jQi e-
Location D dge- iC
Date Pe 1 . 4- 03
SOIL TYPE: Sand-Loa -Clay-
Results of Percola' ion Test
(if applicable) R.te-Minute Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each tr-nch
Depth of trenches
Size of stone
SEEPAGE PITS: N ber-
Size - f . x ft.
Stone size .�
PIPING: S.ze Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Fie14/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tan . feet
Foundation to Absorption _ feet
Separation of Pits' feet
Conforms as per Plot Pla Yes No
LOCATION OF SYSTEM ON P!OPERTY:
(circle one)
Front - Rear - Left S'.e - Right Side
Middle Front - Middl : Rear
COMMENTS:
s-44„„/ /I/4-
/ate
/7,„ V al/,ems c t l y
erda aye ed"de-
SYSTEM USE APPROVED: YES NO
Arrived: /X3r
Departed:
Building nspector
INSPECTOR'S REPORT
Dept. of Community Development
Building & Code Enforcement
Town of Queensbury (518) 761-8256
742 Bay Road 11111ftil
E I ja4
Queensbury, New York 12804
Date:
,` 7 1
Property Location: iii-7,A, i
Owner/Tenant: J417 ii:;
0 BUILDING SEWAGE SIGN
OTHER
REMARKS: [ Tax Map No. )
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CONTACT THIS FICE WITHIN
Building Inspector
/ ' i )
___
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name �11 Lc.'Jl i 1}l C-1
Location e 5'6j
Date .-12-C 7 Permit # —l� 0�3
SOIL TYPE: Sand-(7;
Clay-
Results of Percolation Test-
(if applicable) Rate Minu a/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tot. l L:ngth 1
Length of each trench C Z r
Depth of trenches
Size of stone
SEEPAGE PITS: Number- r
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank 4 fl,/A.,
Tank to Dist. Box
Dist. Box to Field/P' "
Openings Sealed? o Partial
LOCATION/SEPARATIONlip
Foundation to Tank 9 feet
Foundation to Absorption .® feet
Separation of Pits eet
Conforms as per Plot Plan es No
LOCATION OF SYSTEM ROPERTY
(circle one)
Front - Rear - eft Si - Right ide
Middle Front - Mi e Rear
COMMENTS:
LAC.+ �t�(.-0
SYSTEM USE APPROVED: YES NO
Arrived:
Departed: jar,
Building Inspector
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