Loading...
2003-813 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761=8256 BUILDING PERMIT Permit Number: P20030813 Application Number: A20030813 Tax Map No: 523400-295-019-0001-020-000=0000 Permission is hereby granted to: ROBERT&ARNFEBEYERBACT4- For property located at: 6 SHERWOOD Dr 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. Type of Construction Value Owner Address:, ROBERT&RENEE BEYERBACH Septic Alteration Residential 6 SHERWOOD Dr Total Value QUEENSBURY, NY 12804 Contractor or Builder's Name Address Electrical Inspection Agency I.B.S. SEPTIC 2 LOWER WARREN STREET OIJEENSBIJRY- NY Plans&Specifications 2003-813 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday, September 26, 2004 (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 aAh of eerobZ Friday, September 26, 2003 SIGNED BY4�)4V�p IV- 11'.& for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit=Septic Disposal System Town of Queensbury.742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: ............:..:.............................................................................................. /� Office Use Location of installation: . (,} _t t.✓04-c/ �(`.(✓C File Permit No. Tax Map No. )} /) > Fee Paid L' Owner's Name: [ C S— _ Address: cr/r t(i G 2. INSTALLER'S NAME ( } -!z PHONE NO. 3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s) and multiply#of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x ' Computation = Total Daily Flow 1980 or older x 150 gal/bdrm = 1980— 1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm- _ Garbage Grinder Installed yes / no.�-5 Spa or Hot Tub Installed yes_ / no 4: PARCEL INFORMATION: (circle applicable information&indicate measurements) a hSoil-Nature Ground Water Bedrock or Im ervious Materia Dom ater Su 1 F san a4tha depth at w at d pth municipal Rolling Foam feet et we Steep slope clay if well; water supply _%slope other from any septic-system depth: absorption is ft. other. Percolation Test: (To be completed by licensed professional engineer or architect) Rate: minute per inch 5. PROPOSED SYSTEM: For New Construction: -All 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 ands leach field for each Garbage Grinder, Spa or Whirlpool Tub. Septic Tank: 1LlD© gallon (min. size 1,000 gal.) Tile Field: each trench, CS ft. Total System Length: 9 ft. Seepage Pit(s): number of size of each: I. by ft. Size%f Stone to be used: # / depth or thickness feet Bed System Size: x Alternative System: length and/or szze 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency. 7. SIGNATURE &c INFORMATION FOR RESPONSIBLE PERSON(please read). 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 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. 9oCL�_�Oa �'-Signature of responsible person Date • •'ti�tivtt •ctf t�t�t.r.�t�in=rrV ' E st-wer-4 and Sewstl;t: i}i:�ijrcx;xil (:Iix�txft`x• I S,1.11.) Jy4Nr) f 41 j T1�t tY,. I Mf�IL 1, i`j Rt•Lea w y � •w 7. Sl(:x �TUJ�.F 8Z INFORMATION FUIZ�•�Y'Vl`i,yif3L��'rx�v�.�.,vn�•••••••�, Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: - am/pDepart. am/pm. 742 Bay Rd., Queensbuiy,NY 12804 Inspector's Initials. NAME: P--� � � Cv PERMIT NO.: 3 LOCATION: (_Q &>r\-QN(-K3 O�:> INSPECT ON: RECHECK: Comments and/or diagram Soil Type:/_San_d//L2awLCIav DTe of Water cMunicipal 7yell Water Waterline separa-ti-o-n-dTs-5n-ce Well separation distance Other wells: ft. Absorption Field: Total length Length of each trench ft. Depth of trenches Size of Stone 1W seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank ,V/2- Tank to Distribution Box k If Distribution Box to Field Pit 14 r( Opening Sealed: Y/NI Partial Location/Separations Foundation to tank Foundation to.absorption Separation of Pits Conforms as per Plot Plan Y N Location of System on Property: Front Left ide Right Side ear t (9 Left t Middle Front tiddle Rear Status system Use Status Approved Partial Approved and needs to be re-inspected,please call the'Building&Codes Office Disapproved L:\SueHemingway\Building.Codes.Inspection,FORMS\Septic Inspection Reportdoc January 28,2003 I � A .. �..._ I77 LLL lI_ I �. ► f � ► II � � III � �-�II �111__ RD VED va 3em or bsirvai or believe sa ,a ida c of E p, i I II arb a is s c� s hbus s,v ells,t aes enr s,a , l�. f I 6114 fl Q�1 a � GU?'riCn( %?Sa ("',nrdon til't l av4 �{�VVl Ur�t �pt�J ffs 1t� ea f E .Ira UILOIN, A I HJ I ► I l l I l` I I I ..J I_ I 1 , I � _ .1, , c. , c,' I I i I I ► �' � I�' ,o . I I i I I .��.�� BUILD NG AN I D I �1 � I I a ► I I I I ! ► I l l l l l l l l l I I___-l� I I � l l l l l � l l l l ( I I BUILDING & .0 REVIEWED BY i DATE "I have seen or observed, or believe I saw evidence of; all objects such as houses, wells, trees, fences, etc., shown on this document. I also represent That I have personally measured the distances set forth on the diagram." A - *NSI DATE — I 1 ILO t TOWN OF QUEEtNISSURI.�BUILDING DEPARTMENT Based on Our !unit(,{ examination, compliance with our CIomments shall not be construed :as indicating the compliance with the �uildin re Codes of New York state. l CH j 1LE ,CP�. (, WOO d k r(., SAC, .S