2006-242 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20060242 Application Number: A20060242
Tax AIap No: 523400-296-013-0001-080-000-0000
Permission is hereby granted to: Lf"A COMBS
For property located at: 95 MONTRAY Rd
in the Town of Queensbury,to constrict 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: LINDA COMBS
95 MONTRAY Rd Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2006-242
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday, May 02, 2007
(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 Quee ury; uesday, May 02, 2006
SIGNED BY for the Town of Queensbury.
Director of BuildinAf&Co 4Enforcement
ICE USE ONLY ���-- ----'
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, # ,
TAX MAP NO
aZMIT NO PERMIT FEES-? ' '
, ,
APPROVALS: ZONING
TOWN CLERK ; 0
01
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER:- dJ_DQ. 0-M b INSTALLER:
ADDRESS:2� �onlTfwy ADDRESS: �I�✓J1r,a r�a,y It!r�
IJ�fo �-
PHONE NOS._ SI9- 71F p 5-g o l PHONE NOS. s/8 7 91 S8 I
LOCATION OF INSTALLATION: /(tc,R 7V
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:............................................................................................................. ............................................................. . ..... .............................................
NO.OF RESIDENCE INFORMATION
YEAR BUILT X i COMPUTATION= _ TOTAL DAILY FLOW
.......BEDROOMS
......................................... ...... .......i............;.................................................................. GARBAGE G
,1980 or older s X........150 gallon per bedroom............=..............�� INSTALLED?RIN�E6R
.......;............................................. ... : /4
1981 1991 I X `:. 130 gallon per bedroom _......................................................................
;...
j..................I..............I..........' .f.......•...9••....................�..•...••.
.p.............................................' t 1 c
...................•.....................9...........♦..........................................................................t S
1992-present `• '..X....;.......�.10 gallon per bedroom...........-.............................................................................. INSTOL ED? T��_
. B
t. ...........................................1....................................
...........i.
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 SUPLY: MUNICIPAL WELL
(IF WELL: WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. )
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH (TEST TO BE
COMPLETED BY A LICENSED PROFESSIONAL ENGINEER OR ARCHITECT)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by
a licensed professional engineer or architect (unless installed in a Planning Board approved subdivision). Add 250
gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub.
✓ SEPTIC TANK: oy
_l o GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: _FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X FT.
✓ SIZE OF STONE TO BE USED: # /DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY. GAL.
is NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
a;
i APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
I:...:............:.::..............................:......::.....:........:................................::...........................................:............
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any
permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation or
failure to make a material fact or circumstance known 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 QUESTIONS? CALL 761-8256 OR EMAIL
Queensbu Sanitary Sewage Disposal Ordinance. codes@aueensbury.net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensburv.net
Si nature of Pers n Responsible Date
QTown of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804