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historical information gg L o w S►7 uo1�OaS .. . Crf y �� n�e��p�? • hJ) ems;U2Dt� Jo urno,L . i . • ® O t=f gDUgJO 2f" d•oW )(DI_ g Zs vosu o aso N p�buOD h�_1au�_1oj ..►O me eput�l ?r+ .. s -� y _c d. a t�o_aa / _ \ _ . I Gr ,oil ' \\ \\ �• aU pa.o_sd \ \ \ II +sal \1 I. „' ♦ _pag yF'r 0- aloes{ $1. • �'a /�� / �� / a/ 7 .,t+c•,te,_ , Arrt— fji 1'4nr auapisa ' -i,___JI/ I oJ -1 a. • vW • LEIL9 Z9- C-WOuT,' ._ J itd „V77 >ill01 al Ada j OOC 94L.- 8• . I _, • f C�10i}D�C�`dw 111 i" M® 0 9 tl $� uoLuJou jo h QLUJo. Jo mou Spiro l QoWn of Qur 4i7'7UI BLDING and ZONING DEPARTMET Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION . I i Nate ' r - -oo� LOCATION y/ // /' DATE /G'/'/0.-- PERMIT NO. 4 G : '1v 0� SOIL TYPE d oam - Clay Percolation Required? YE - NO Percolation rate, - Min/Inch TYPEof SYSTEM: v fI' , Absorption 'field, total leng;0h ro Length of each. trench.' 3d Depth of trenches r; 1 j.j Size of gravel S a SEEPAGE PITS{Number Qf) Size- ft. X ft. . ~ Gravel size , PIPING: `Sizeli Type 4�1 Bldg. to tank L� POr Tank to dist. box ild,1 Nil - Dist. box to field/p`' FII/J Openings sealed? I NO Partial + ;t LOCATION/SEPARATIONS: /, Foundation to tank;' `x/Qft. Foundation to absorption 5C2ft. Absorption to lot line / ft. Separation of pits 0, ft. LOCATION OF SYSTEM ON. PROPERT;Y(circle one) Front - Rear - Left side - Right side - COMMENTS: ; +^ S- S91 . mho Lc- SYSTEM USE APPROVED 6 NO 1 t 6 . Building Inst tor 01/86 and vl BUILDING PERMIT - H TOWN OF QUEENSBURY No. 88-782 WARREN COUNTY, NEW YORK z • PERMISSION is hereby granted to GEORGE & VIOLA COOK OWNER of property located at HALL RD GLEN LAKE , Street,Road or Ave. in the Town of Queensbury,To Construct or place a SEWAGE 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. O WNER'S Address is 10609.SARATOGA ROAD SOUTH GLENS FALLS,N.Y. 2.`CONTRACTOR or BUILDER'S Name t=i 0 tli 3. CONTRACTOR or BUILDER'S Address R-+ H 0 a 4. ARCHITECT'S Name 0 0 5. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) ( )Wood Frame ( ) Masonry ( )Steel ( ) �- r+ 7. PLANS and Specifications 9 No. 1000 gal tank,65' tile field, as per plot plan,specifications, r and application. t� 8. Proposed Use SEWAGE ALTERATION tri $ 10.00 PERMIT FEE PAID—THIS PERMIT EXPIRES May 1 1989 rn (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the tzi town of Queensbury before the expiration date.) t'r1 Dated at the Town of Queensbu 14th Day of October 1988 • C17 SIGNED BY / for the Town of Queensbury Building and Zonin I spector 0 C� PRO .Jcrien 0O Oue,,,,,d4r, Df ttde / i3. 2 h.`I�- J -�9 APPLICATION FOR SEPTIC DISPOSAL PERMIT //1 DLDG t�ES 20ti1HG b DLDO , DES DUI. TOWN OF QUEENSOURY DA'1' e . / 17 LOCATION OF PROPERTY FOR INSTA LATION (217,7hi, , Owner's Name: Zz"� Telephone: ."7. 3/7 Address: _ , •• C ' ] �� A Installer's Name: j7Z • 61 Telephone: d 2- 7/7 Number of bedrooms (residential only) _ _ Total daily flow (compute @ 150 gal per bedroom) _ �. e Topography: circle one: Flat olli. _ Steep Slope % of slope l _ Soil Nature: circle one-Loam Clay Other / Depth: V feet Ground Water: At what depth? ‘ feet Bedrock or Impervious Material: At what depth? > Z feet Percolation test: circle one: not required required / rate. min. inch. Domestic water supply: circle one: Municipal grir Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorption _//d, feet PROPOSED SYSTEM: Septic Tank /441 gal. (minimum size: 1,000 gal.) TILE FIELD: Each Trench c8 feet / Total system length G.� feet SEEPAGE PIT(S): Number of / Size each .. feet Dy feet Size of st9,5e.4o be used ii Depth or Thickness / feet - * * * * * * * 4, * 4. +.0-4 i-* * ' * *Y V-fi.: *efe:Arx-v--,4-476z iee-(-7 iej IMPORTANT " ...Please—LIST NEW EQUlPIvMEN'1"1'O BE INSTALLED * * * * * * * * * * * * * * * *j. * * * * * * * ; `f« * *1, * /* * * * * s * * *�i 7'. lilt/11V/7/71111g/ .64 a, •47E,'7 e/ dokt/I, 4 /�P !�` e � �'`� "'lei: ' ze)./.61,:eirr Lle,:e&e- 4. . .,,f/2- -z3(f,e_ , (over) . • • 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 2i) location and distance to lot lines 3.) location and distance to structures 44.) location and distance to any water supply 5.) size and dimensions of all tanks, distribution boxes, tile fields and/or drywells B: 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 regulations above and agree to abide by these and all requirements of the Town'of Queensbury Sanitary Se ge Disposal Ordinance. Signature of res onsible perso � Date: A 5 /9ff • Town of Queensbury Building and Code Department flay at Haviland Road / Queensbury, New York 12801 • • (518) 792-5832 • t ' 6z je/G17) 8881,13S G2 Dteunrmao Met h- i I {is}ap.uo!}o1S 1 .00 i-i49.zg,att'ghi°.ik, - suo))o6-Or=,,..V. 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We look forward to completing a thorough inspection for you. You can help us do the best job possible by providing some advanced information about the site. Prior to our inspection,we request this completed application, a site map indicating the location of the septic components and confirmation the pre-inspection preparation (see the last page of this packet) will be completed prior to our arrival. Enclosed is a Septic System Inspection Information form, which must be completed, signed and returned to this office, with the appropriate fee(s) and documentation, prior to scheduling an inspection. Please note the Town of Queensbury's fee for this service is $250. Be advised that all fees must be paid prior to scheduling the inspection. We require 48 hours notification prior to scheduling the inspection. If the purchaser is requesting an exemption, please submit this application along with a notarized letter stating the septic system will be inspected or repaired/replaced within 6 months from the date of the Property Conveyance or June 15t of the current, or following year (whichever comes first), a map locating the septic system and payment totaling$2250 ($2000 refundable deposit plus $250 permit fee). The deposit is forfeited if the owner fails to-complete the repairs or installation as stated above. If you have any questions, please call. Phone: (518) 761-8256 Email: kated@queensbury.net Thank you. � � � � � - L� sincerely, OCT 3 0 2019 (1"- afi 4 `✓ s":9 TOWN OF QUEENSBURY BUILDING&CODES David Hatin, Director Building and Code Enforcement Town of Queensbury Property Transfer Packet Revised September 2019 Office Use Only Permit#: - 2.0 15 • Town u(CLrccn.cbun' Fee: 2.t© 742 Bay Road,Queensbury,NY 12804 P:518-761-8206 or 518-761-8205 Invoice#: www.queensbury.net SEWAGE DISPOSAL SYSTEM INSPECTION INFORMATION Individual Residential Wastewater Treatment System Property and Owner Information: (Please attach property survey or tax parcel map) Property address: 9 y a/e6-7,wxy Tax map number: 4229 Property owner: / 1-4/-7-/-0,Afy r ge��i✓Ae-e_41--A_//1 Mailing Address (c/s/z): 1770/ T r771 s--- %'r G 7 4,1 /Y V, 7 /U/2' Cell#: j/t 'PJ P'?V Land Line#: .ci 6o1 ‘/?Y Email: i 7 bA1 Y, "=e-4//4/ Of-'4' :C'/t **PLEASE SEE SEPARATE PAGE FOR EXEMPTIONS** Household Information: #Bedrooms Z. #Bathrooms ( #Kitchens Onsite Wastewater Treatment System: How many systems are on the property? I Year system(s) installed: Tank, Size of Septic Tank/?'re Type of Absorption System: L� Are all system components wholly within the property boundaries? Cs ❑ No Are system plans available? "Yes D No / Does the system(s) serve multiple properties? El Yes L1'No If yes, describe Maintenance: Service agreement? El Yes L�1 No If yes,vendor name �' Date of last inspection N/A IfiDate tank last pumped N/A Ifi Frequency of pumping N/A Cr Property Transfer Packet Revised October 2019 List known repairs/replacements,with dates: Date Type of Repair/Replacement Operation: • System problems? Yes C.No • Sewage odors? Yes (No • Direct surface discharge(s)? Yes V No • Back-up of toilets? Yes _B No • Back-up of any other fixtures? (e.g. slow drains) Yes No • Seasonal ponding or breakout of leach field? Yes 1,1 No Statement of Acceptance of Conditions: I agree to: • Ensure that the septic tank(s), distribution box (es), and/or seepage pit(s), if any, will be uncovered prior to the requested inspection time; • Have a septage hauler on site (to pump the tank after*the inspector verifies flow from fixtures); ➢ Tank must be pumped in presence of inspector • Have an authorized representative present at the site; • Allow the inspector to verify information provided above, and to conduct an inspection of the indicated onsite wastewater treatment system(s), including all system components and interior plumbing in crawl spaces and basements. To the best of my knowledge,the information provided above is accurate and I acknowledge the following: After 1 year from date of submission and there is no activity on this permit,the permit will expire. In addition, if the permit is withdrawn 20% of the fee is retained by the Town of Queensbury. Signature of property owner or authorized agent Please print name: c e,a, YIV/c K Affiliation: o er a ent 1" Signature: Date: if Prior to schedu t he Town of Queensbury,you MUST: 1. Schedule a sewage hauler to be on site to pump tank while inspector is on site. Hauler should arrive 30-45 minutes after scheduled time with the Town of Queensbury's Code Enforcement Officer. 2. Expose inlet and outlet of septic tank, and/or pump station, expose d-box, expose any seepage pit covers. 3. Excavate test hole in leach field if there is no d-box. • Property Transfer Packet Revised October 2019