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TOWN OF QUEENSBURY
742 BayRoad, Queensbury, NY 128045902 (518) 761-8201
Community Development -Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20070194 Application Number. A20070194
Tax Map No: 523400-308-019-0001-033-000-0000
Permission is hereby granted to: DAVID & SHEILA DESROSIERS
For property located at:
46 OGDEN 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 Queensbury Zoning
Ordinance. Tvne of Construction Value
Owner Address: DAVID & SHEILA DESROSIERS
46 OGDEN Rd
QUEENSBURY, NY 12804-0000
Contractor or Builders Name /Address
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY. NY 12804
Septic Alteration Residential
Total Value
Electrical Inspection Agency
Plans & Svecifications
-194
CIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Sunday, April 27, 2008
(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 own o e ut~ r' a pril 27, 2007
SIGNED BY /„V/ for the Town of Queensbury.
Director of Building & Code Enforcement
RED ~~,~'
~ ~ OFFICE USE ONLY ~ ~ ...,...........`~""".~
~~ ~ q ~ l ~~ ~-- ' ~ _ ~ . ;
~ TAX MAP NO. ~- '
PERMIT N0. PERMIT F~~ ~'Vf~;~;~ ,_ ,,,:a.~RY ;
~ _.
~ APPROVALS: ZONING TOWN CLERK BUILDITIG ~fJD LODE ;
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: INSTALLER: r- ~ ~/~
ADDRESS: ADDRESS: ~ ' -~~ ~C/ ~" _,/' ~/'C-v~ S/
PHONE NOS. PHONE NOS._ ~ ~i~~ ~/
LOCATION OF INSTALLATION: T ~ Al~ ,.R-i' ~ /
YEAR BUILT nc~• °F
...........» ................»......... ..»BEDROON
1980 or old®r
.»...1981 »• 1991 » ..... .......................».....
...1992 •~present .. ...............................
PARCfiL INFORMATION:
X ! COMPUTATIONa
X 150 gallon per bedroom
........................»g .............p...............
X 130 allon er bedroom
X 110 gallon per bedroom
.......~ ............................»,,.,.................,,....,.....,........: RESIDENCE INFORMATION:
_ ,TOTAL DAILY FLOW
................................................................................! GARBAGE GRINDER
°_ , ; INSTALLED?
'•. SPA OR HOT TUB
{ INSTALLED?
/ TQPOGRAPHY: FLAT OLLING~ STEEP SLOPE %SLOPE
/ ,SOIL NATURE: SAND LOAM CLAY OTHER
/ GR;OUNDWATER: AT WHAT DEPTHS BEDROCK/IMPERVIOUS nnaT~
WHAT DEPTH? RIAL: AT
/ 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: Ail 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 ~~ GALLON (MIN. SIZE IS 1,000 GAL.) TIL FIELD: EACH THE
NCH C~ FT.
/ ~TAL SYSTEM LENGTH: ~FT. SEEPAGE PIT(S): HOW MANY?
/ SIZE OF EACH FT. X FT.
/ SIZE OF STONE TO BE USED: # /DEPTH OR THICKNESS FT.
/ ~D SYSTEM SIZE: X
/ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
/ HOLDING TANK SYSTEM: (If required) N0.OF TANKS: /SIZE OF EACH
/ GALLONS. /TOTAL CAPAC/TY.• GAL.
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY PLEASE REVIEW LIST PROVIDED
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 factor 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~aueenab ~~ „..
VISIT OUR WEBSITE FOR MORE INFORMATION
www pueenabury net
nature of Person Responsible Date
.; Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
~~~~~~
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: a'~ ~ ?
Queensbury Building & Code Enforcement Arrive: am/pm Depart: ~ a /pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: ~ ~' lQ~
NAME: L"~S PERMIT NO.: _ - l
LOCATION: INSPECT ON: ~..~
RECHECK: 1~~
,~--` ~~mments ana~or aiaaram
Soli T Cla
T of Water: u Well Water
Waterline se ration distanoe ft•
Weil separation distance
Other wells:
Abso Fiek1: Total len h
Le of each trench ft•
ft•
~~ ft•
~ ft•
of trenches ft•
Size of Stone
Pits: Number
'
Size:
x
Stone Size:
Pi i Size T
Buildi bo tank
Tank to Distribution Box
DisMbutlon Box ' Id Pit ~`
O ni Sealed Pa I
End Ca
In Outlet Pi & Baffles Y N
Location rations
Foundation tD tank 'i- ft•
Foundation to abso ion ~ ft•
Se ration of Pits ft•
Conforms as r Plot Plan N
F As-Built N
Locatlon of System on Property: ~~ ~ ~,C~~
Front ear Left Side Right Side
Middle Front Middle Rear
~ m
Approved
Partial Approved and needs to be re-inspected, please call the Building & Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
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