95-452 BUILDING ' PERMIT
VALUE $ 0 TOWN OF QUEENSBURY 95452
TAX MAP NO. 13. -1-10 No.
WARREN COUNTY, NEW YORK
HODGKINS. JOHN & DOROTHY
PERMISSION is hereby granted to
CLEVERDALE RD.
OWNER of property located at Street, Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC 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. OWNER'S Address is
CLEVERDALE ROAD
CLEVERDALE, NY
2. CONTRACTOR or BUILDER'S Name
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( 1 Masonry ( I Steel ( )
7. PLANS and Specifications
SEPTI@o-ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 August 13 97
$ 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 Queensbury before the expiration date.)
Dated at the Town of Queensbury this 15 Day of August 19 95
SIGNED BY for the Town of Queensbury
Bull ing and Zoning Inspector
TOWN OF QUEENSBURY j
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit #
9 LISO,
Fee Paid
Date: Rev`ewed By
LOCATION OF PROPERTY FOR INSTALLATION: (1._%TlUZ11-1), _ kQ
t449)
Owner's Name: O l ,1l�f . o GOMS M
Owner's Mailing Address: 05(0 £K137 ,L, 31 )C bou , 1! 14n1, /Uy
IZI10
Installer's Name: Phone #:
Number of bedrooms (if residential ): . I
Total daily flow (residential-compute @- 150 gal . per bedroom): 10 C4 110— kk.1
Ftdlk)
Topography-Circle One: Flat Rolling Steep Slope % of Slope .1X—ZF
, Soil Nature-Circle One(Sand Loam Clay'`' Other . /Depth:
Ground Water-At What Depth? 2> cS Feet
ttECEIVED
Bedrock or Impervious Material-At What Depth? Fee
Percolation Test-Circle One: Not Require Required/ ate e Min. PeAlikt0 7 1995
Domestic Water Supply-Circle One: Municipal Well Oth�er o uAEmED uY
If domestic water supply is a well -
Separation: Water supply from any septic absorption ) O feet
PROPOSED SYSTEM: Septic Tank { 2 S O gal . (Minimum size: ' 1,000 gal . ) .
Tile Field: Each Trench feet//Total System'Length feet
Seepage Pits)..: Number of / Size each: ft. x •ft.
Ab oyifJ^Iz A\ l ecQ S' X Sc..) I
Size of Stone to be used: 43/41-t)12/ Depth or Thickness feet
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks Size\of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
agency.
****************
I have read the regulation on the reverse side of this sheet and agree to abide
by these and all requirements of the T wn of Qu ens u y Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: DATE: 5�
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
2) location and distance to lot lines
3) location and distance to structures
4) 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 propdr -installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
Town of Queensbury
Building & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
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DRAW
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HODGKINS RESIDENCE OEcKm JEH
=` TOWN OF Q UEENSB URY DRAWWG NO.:
WARREN COUNTY, N.Y.
0� 4 JAMES E. HUTCHINS, P.E. 95-035 -01
oA P.O. BOX 220, 199 CIRCLE AVE. SHEET i DATE PFIN EO:
t Cl NORTH CREEK, N.Y. 12853 OF �