2007-175
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TOWN OF QUEENSBURY
742 BayRoad, Queensbury, NY 12804-5902 (518) 761-8201
Community Development -Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20070175
Application Number. A20070175
Tax Map No: 523400-295-014-0001-019-000-0000
Permission is hereby granted to: CHRISTOPHER & SUZANNE BROOKS
For property located at:
43 BENNETT Rd
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 QueensburyZoning
Ordinance. ~e of Construction
Owner Address: CHRISTOPHER & SUZANNE BROC Septic Alteration Residential
43 BENNETT Rd Total Value
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name /Address
Plans & Specifications
Value
Electrical Inspection Agency
-175
ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, April 24, 2008
(If a longerperiod is required, an application for an extension must be made to the code Enfoirement Officer
of die Town of Queensbury before the expiration date.)
Dated at the To eensb T` uses ay, April 24, 2007
SIGNED BY for the Town of Queensbury.
Director of Building Code orcement
~~i~i--is~ir~iii~n
i~ i r ~ ~ i~ i~~ i~~~~ r~. r~
OFFICE USE ONLY ~ ~'""""-------------,
;TAX MAP N0.
PERMIT NO.~~ERMIT FE ~' /~
/ '~
APPROVALS: ZONING TOWN CLERK ~ ' ~
,~
APPLICATION FOIZ SEPTIC DISPOSAL SYSTEM PE 7~ ~ ,~
A PERMIT MUST OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFOl RE gIT~
PERMIT. SUANCE OF A VALID
OWNER; ~ ~ /
INSTALLER ~ l S. ~~/,
ADDRESS: __ I (NvG~ l-~
PHONE NOS,
LOCATION OF INSTALLATION:
YEAR BUILT NO. OF - .. ...............................................................
..... ,,,,
BEDROOMS X COMPUTATIONa
,..
....
1980 or older
~ ..X.. .....
..............................................:..
..»
.... .:.,....
.. 150
gallon per bedroom
1'1991 ...
.. .
X.. 130
gallon
per
bedroom
.......................................
1992
,,,,,,,,,,,,,,~~~-.,present,.,
......................................._..... .
..X..
.... ,,.
.
.
,
,
110 allon
9 per bedroom
PARCEL INFORMATION:
i
ADDRESS: _ f ~..an/'vS/
PHONE NOS. ' ~// Y
......' .............'....'.'..".....'~~............... RESIDENCE INFORMATION:
~ TOTAL DAILY FLOW
..........
...
........ .......................................:..............i CiARBAQE QRINDER
a INSTALLED?
,,.., ..1.... ...~ .................................
a
.....,,i ................................................................. i SPA OR HOT TUB
_ INSTALLED?
/ TOPOGRAPNV; FLAT ROLLING STEEP SLOPE
/,SLOPE
/ ,SOIL NATURE: SAND LOAM CLAY OTH '
ER
/ N W T ~'AT WHAT DEPTH
WHAT DEPTH BEDROCK/IMPERVIOUS MoT~PI^L; AT
/ OOMESTI .WATER SUPLY: MUNICIPAL,
WELL
(IF WELL: WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS
FT. )
/ _PERCOLATION TEST: RATE IS
COMPLETED BY A LICENSED PROFESSIONAL ENGINEEIR OR ARCHITECT(TEST TO BE
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by
a licensed professional engineer or architect (unless installed in a Plannin Board a
gallons to the size of the septic tank and leach field for each garbage grinder, spa oPwhi (pool tubivision). Add 250
/ SEPTI TANK: ~v GALLON (MIN. SIZE IS 1,000 GAL.) TIL FIE D: EACH TRENCH cc//,,
/ TOTAL SYSTEM LENGTH:G~~ L~.FT.
FT. SEEPAGE PIT(S): HOW MANY?
/ SIZE OF EACH FT. X -.____._.FT.
/ SIZE OF STONE TO BE USFn; #~ /DEPTH OR THICKNESS__L___FT.
/ BED SYSTEM SIZE: X
/ ALTERNATIVE SYSTEM:
LENGTH AND/OR SIZE
/ HOLDING TANK SYSTEM: (if required) NO, OF TANKS: /SIZE OF EACH
/ GALLONS. n'OTAL CAPAC/TY.• GAL.
NOTE: ALARM SYSTEM AND
APPROVED ELECTRICAL INSPECTOION AGENCYCTRICAL,WORKMOST BE INSPECTED BY~A TOWN
...........:.........:......Y,.,...,.,.,.~,...,.........:,,...,.:.,.....,.,.,.,.,.,.....,.......,...,.,.,,~.,.;.,.,...,.,.,.,.,...,.:...,.........,.,.....,.,.,.:.,,,PLEASE;.REVIEW,LIST ,PROVIDED:......,„.,...,...,.....,,,.,...,.~...,...,.,.,.,.,....,,:,.
For your protection, please note that pursuant to Section 136.29 of the Code of the Town of Queensbur , an
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
Queensb anitary Sewage Disposal Ordinance.
nature ofi Person Responsible Date
QUESTIONS ? CALL 781.8256 OR EMAIL
s~aueenaburv net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueenab~rv net
Town of Queensbury ~ Community Development Office • 742 Bay Road, Queensbury, NY 72804
Septic Inspection Report //,,
Office No. (518) 761-8256 Date Insp~on request received: 7 ~ ~ ~
Queensbury Building & Code Enforcement Arrive: f ~ am/,fig, Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: ~~
NAME: r~ ~S
LOCATION:
RECHECK:
PERMIT NO.:
INSPECT ON: 0 7
Soli T Sa Cla
T of un' Weli Water
Waterline se ration distance ft•
Well separation distance
Other wells: ft•
ft•
Abso Field: Total len ft•
of each trench ft•
of trenches ft.
Size of Stone 2-
See Pits: Number
Size• x
Stone Size•
Pi in Size
Buildi bo tank
Tank to Distribution Box `f
Distribution Box geld Pit ~L
O ni Sealed: N Partial
End Ca
in Outlet Pt & Baffles Y N
Location Se rations
Foundation fio tank -~ ft•
Foundation to abso ion ft•
Se ration of Pits ft•
Conforms as r Plot Plan Y N
E ineer Re rt and As-Built Y N
Location of System on Properly:
Front ear Left Side Right Side
Middle Front Middle Rear
5Y~~1-~~
Approved
Partial Approved and needs to be re-inspected, please call the Building & Codes Office
Disapproved
Last revised 021006
Last revised 1/6/OS
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