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TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
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Community Development- Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20150126 Application Number: A20150126
Tax Map No: 523400-309-009-0003-014-000-0000
Permission is hereby granted to: TODAY'S MODERN MOBILE HOME SALES, INC.
For property located at: 96 CENTRAL Ave
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: TODAY'S MODERN MOBILE HOM:
PO BOX 4727 Septic Alteration Residential
SARATOGA SPRINGS,NY 12866-8 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2015-126
septic alteration
$40.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday,April 30,2016
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town ofry; T urs , pril 30,2015
SIGNED BY c J)aJ" for the Town of Queensbury.
Director of Building&Code Enforcement
17`27-:_:..0 _ u,
DATE y 274:sit E . ' li
x I. . b°ci . q- -,1z}
TAX MAP ID APR 2 8 U rmi .. 2015-12_L.
/ / .:;)Fee D ' Y�vcl
LDING
LOCATION OF INSTALLATION �t0 f arc--F QU E:N '+ �
& i�' goals:
APPLICANT /D,.,4'-!S / ' l 0 pc--/ /ti / A-ms- PHONE/E-MAIL 7671YUi)T 0 'QC cCL"IT
ADDRESS eo.zOn / 727 J Gt/1Q�[�1c� i ri nos / A) `t f 2A, l�
c l
INSTALLER/BUILDER: J, I-r PHONE/E-MAIL r 9 -222-369 Si
ADDRESS:
OWNER "S' in E- PHONE/E-MAIL
Address
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: aoe up PHONE 222-365')6-
RESIDENCE
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom -Total Daily Flow
1980 or older Garbage grinder installed Y 41,
1981-1991 Spa or Hot Tub installed ^Y N J
1992-Present .3 / (0 330
PARCEL INFORMATION
Topography Flat rolling Steep slope %slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth?
Bedrock/Impervious Material At what depth?
Domestic Water Supply Municipal Well(if well, water supply from any septic system absorption is ft.)
Percolation Test Rate: per minute per inch (test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size (,000 gallons(minimum size 1,000 gallons, add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length is p ft.;Each trench tam' x 3D`= "
Seepage Pit with#3 stone How many: ;size (./S1/2? -2-711115'6--(0,1-Pj'a%(0/ Ch‘'''l'VI
Alternative System Bed or other type? Sip'7-e/v) 0.,-.51/4110(.4
Holding Tank System Total required capacity? Tank size #of tanks
0¢0416 R- 4/0/1)7) 1?)7>J41 416 SyfE, i /y (S' E 6E-,z/674L 79/2 6,1
Notes: 1)Alarm system& associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer
allow systems to be covered until such time as an As-Built plan is received & approved. The installed system must match the septic system
layout on file-no exceptions.
DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or
failure to make a material fact or circumstance know by or on behalf of an applicant, shall be void. I have read the regulations
and agree to abide by t e and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: ' OSE-Py- 4,4z4P.z" Date: /2-7//sCSignature: �'I � Date: r
i
Town of Queensbury Building &Code Enforcement kV1/ _
Office No. (518) 761-8256
Septic Inspection Report
Inspection request received: /S/7
Name: J (- } S i11pdc=/ d 'c l7 r ( &Inspected on: 5 /
Location: 9 ( t F A (4-e- - Arrive: -i� _I.� , p.m.
Permit No.: !S- /Zi Inspector's Initials: g�
Co ents and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+/- Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
B gtotank
Tank to Distribution Box
Distribution 13-linotter5715it
Opening Sealed: Y N `'A>L VC))L
End Cap Y N
Inlet/Outlet Pipes&Baffles Y N
Manholes 12"or less below grade Y N 1
[provide extension collar if Yes] Y N
Location/Separations ► clZ_Fi
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
ETU Maintenance Contract provided Y N
Location of S stem t;,: :
Front Rea - Sid- Ri.• ide Middle Front Middle Rear
S stem Use Stat .:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
Town of Queensbury Building &Code Enforcement l't E
Office No. (518) 761-8256 -AIAUf \OA v1
Septic Inspection Report
Inspection request received: =J11 15
Name: o ` M060/n ' 1lip✓Yltp Inspected on: 5 `5
Location: Ib � Cvk Arrive: a '4 a.m./p.m.
Permit No.: 15— \2 ' Inspector's Initials:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft. 33() Z22. — �jy
Well separation distance ft. I
Other wells: ft.
Well Casing Length 50'+/- Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box l X236
Distribution Box to Field/Pit /- (Z ris C
Opening Sealed: Y N � "2V
End Cap Y/ N
Inlet/Outlet Pipes&Baffles
Manholes12" less below grade
[provide extension
nsisi on collar if Yes] Y N,
Location/Separations
Foundation to tank ft. �� — - "'_�
Foundation to absorption ft.
Separation of Pits ft. r��
Conforms as per Plot Plan Y N J(/)
Engineer Report and As-Built Y N
ETU Maintenance Contract provided Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
S stem Use Status:
Appr•v-•
'a •• • -: . d needs to be re-inspected, please call the Building &Codes Office
I approved
Septic Inspection Report
Community Development Office 0( ((J
`, Town of Queensbury • 742 Bay Rd. ')
Queensbury, New York •12804 PLOT PLANA cc1,1 pc _ i\t/ _. . .
a
Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines.
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