99-123 PIP"P
BUILDING PERMIT
TOWN OF QUEENSBURY No 99123
VALUE 0
2
TAX MAP NO. 7 . -1-13
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to
Street,Road or Ave.
OWNER of property located at
in the Town of Oueensbury,To Construct or place a
at the above location in accordance to application together
d tthg plotan plansi and
Odot hanc er information hereto filed and
approved and in compliance with the Town of Queensb ry
OWNER'S Address is
STARK, JOHN & SUSAN 1645 RIDGE RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
STEVENSON, WALT
3. CONTRACTOR or BUILDERS Address
4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X) SEPTIC
( )Wood Frame ( 1 Masonry ( )Steel 1 1
7. PLANS and Specifications
SEPiitC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
B. Proposed Use
SEPTIC ALTERATION
April 13 2001
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES
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 Oueensbury before the expiration date.)
13
April 1999
Day 19
Dated at the Town of Queensbury this of
p`Torthe Town of Queensbury
SIGNED BY
Building and Zoning ttspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury qq- )(23
mm
Dept. of Couniry Development Permit No.
Building &Codes Office
742 Bay Road
Fee Paid S
Queensbury, NY 12804
1 (04�Location of property for installation: 211 -/3
Property Owner's Name: `i.4A, W
Property Owner's Mailing Address: I (,L15- /' U ✓ -/ L{P��✓.�u�; ? -
Installer's Name: i tL f ,«,y f- rE Phone #
Gto Qh S . 9"14 ci"."
Number of bedrooms (if residential): 3 Total daily flow:
(residential - compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other /depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? feet
ED
Percolation test: not requires, required [rate min. per inch j
R ECG
Domestic water supply: municipal, well, other APR 1 1999
GOWN OF OUEENSBUIR'
If domestic water supply is a WELL, water supply from any septic absorption is _E3UILDIfeetANn
PROPOSED SYSTEM
Septic tank gallon (minimum size: 1,000 gal.) 6AA7
Tile field: each trench feet / o syst:.em length: feet
Seepage pit(s): number of cis: . ft. by ft.
Size of stone to be used: # / depth or tfiiclmess feet
•
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
(Alarm system and associated electrical work to be inspected by a certified agency.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any permit or
al yruval 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
Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: %2et/ii-z (f-° )1- Date: 41/02-71
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
r
Location I(,`71.r � ✓
Date -{tiSS Permit #
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation 1‘est-
(if applicabi.gg) Rate-Min e(Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: To -al Le gth
Length of each, tren h
Depth of trenches
Size of stone
SEEPAGE.PITS: N 'mber-
Size - ;t x�� V ft.
Stone size
PIPING: \: Size 'Type
Bldg. to Tank '
Tank to Dist:` Box
Dist. Box to Field/Pi-t-4),
Openings S-.led? Yes%" No Partial
LOCATION/ PARATIO :
Foundatign to Tank /G feet
Founda on to Absorption / feet
Separation of Pits AI eet
Conforms as per Plot P1 an Yes 2No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side Right Sidi
Middle Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YES iNO
Arrived: c,33°
Departed:
Building Inspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name if4(c r,,�
Location /40- ,"ife
Date f3 f' Permit # 4j-/23
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: .tal Le .th
Length of each t'ench
Depth of trench:s
Size of' stone
SEEPAGE KITS: Number-
Size - . x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sea ed? Yes No Partial
LOCATION/SE'ARATIONS:
Foundation Ito Tank feet
Foundation to Absorption feet
Separation of Pits _ feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
,// �C•* n-
SYSTEM USE APPROVED: YES 4
Arrived: r- ''/ )
Departed:
Building Inspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name„-,; c..r -/c'
Location e
Date 1„, 4rf Permit # 9i—/t)
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total ength '
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Numb:r-
S i z e - ft. fL.
Stone size
PIPING: e ype
Bldg. to Tank
Tank to Dist. Bo-
Dist. Box to Fi :ld/Pit
Openings Sealed' Yes No Partial
LOCATION/SEPARA IONS:
Foundation to T:nk feet
Foundation to A'sorption feet
Separation of P'ts _ feet
Conforms as pe Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
/Vo r-ek(
SYSTEM USE APPROVED: YES NO
Arrived: c6
Departed:
Building Inspector
— .,e_)• 5,,,b_
-( :3
Oei REccENED
APR 1 6 1g99
TOWN OF QUEENSBURv
3U1LDING AND CODE
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TOWN 3F QUEENSBURY
BUILDING & EPT.
REVIEWED BY / .44
DATE