2001-457 'J TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
0.4r0
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: . P20010457 Application Number: A20010457
Tax Map No: 523400-315-006-0002-005-000-000
Permission is hereby granted to: SCOTT& LYNN ALLEN
For property located at: 651 CORINTH 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. Type of Construction Value
Owner Address: LYNN HITLIN Septic Alteration Residential
PO BOX 752 Total Value
GLENS FALLS,NY 12801
Contractor or Builder's Name/ Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications .
2001-457 SCOTT&LYNN ALLEN
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Friday,June 27,2003
(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 To of eens W e Ji ay,June 27,2001
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
,/a = Application for remit—Septic Disposal System
Town of&eens/nny 7.12 By Reuel Queen.th,u , NI 12804 (518) 761-82.56
1. OWNER INFORMATION;
( t9 Ullice Use
Lvcntiou ol'iustallation: v�`, —Tax Map No. / / Kilo I'o►mit N672 02. J7
Owner's Name: Cf C 9 77- lt/,U 411 L/Li co1' Paid �5>
Address: (O S l C t A-1TP 10) .
2. INSTALLER'S NAME : Xi,' - Ac,'0,--%._ C PHO
N N0.79i—
72.5 7
3. RESIDENCE INFORMATION: (circle year of dwellin t► indicate >„ ca/c I!bedroom(s) and nwlliply If o/'
bedrooms with applicable gallons per bedroom to Neal lulr.►!(!ally plum)
Year of House; No, of Bedrooms x cou!pula(iuu - 'Total Daly Flow
1980 or older 1_ x 150 gal/burnt = r:CO
•
1980- 1991 x 130 gal/bdrnl = REOF i VET'
1991 -present x I I U gal/bllrm =
JUN 2 5 2001
Garbage Grinder Installed yes / no
Spa or Whirlpool Installed yes / no x SOWN OF QUEENSBUFdY
BUILDING AND'CODE
4. • PARCEL INFORMATION: (circle applicable information & indicate measurements)
_1_ra.hh S _'._Na uro Ct9.(I s Waiter_ Bedrock or Impetvim's Mate'ial _I)
W? at what depth at what depth Ws,tc r Sut,hly,
/ JJr►a►icl ,or
Rolling feet feet (�...,.� /
Steep slope clay
slope other if'well; water supply
depth; from any stink-system
obsulpllon is fi.
Percolation Test: (I o.be eompleied by licensed pretssivnal engineer or architect) other_
Rate: _ minute per Inch
5, PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems roust be designed by a licensed
professional engineer or architect(unless installed in a Planning IJuard:Ip>Inused subdivision), Add 250 gallons to the size:
• of the septic lank and leach field fur each Garbage Grinder, Spa or WhiiIpool Tub.
/ �xiJ /A) G
Septic Tank: l OD D gallon (mutt. size 1,000 gal)
1
Tile Field: each trench if°' fl. Total System Length: a2 t2-° fl.
Seepage Pit(s): number of /i 1/4" size of each: fl. by fl•
Size of Stone to be used: it 1" / depth or thickness _•7c,c,t
I3ed System Size: 4 x .
Alternative System: / . 4-- length and/or size
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'I'own approved
electrical inspection agency.
7. SIGNATURE & 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 malarial misrepresentation or failure to make a material Fact or
circumstance known by or on behalf of an applicant, shall be void.
I hay. • the regulations wills respect.to this application and twee to abide by these and all .
requl cutout of the Town of ' cnsbury Sanitary owaga Disposal O►clinance.
_____W:11
gnature of respo 1 Ible person Date
s. 1
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name Pj1)\,-OV‘ -1'\4 in �lipS1
Location �'
Date cl )/p :�4 ;llPermit
SOIL TYPE: ,arid o., -Cl ay-
Results of 'ercolati .n Test-
(if applical.le) Rate- inute/Inc h
TYPE OF SYS EM:
ABSORPTION IELD: Tot:l Lengtf� �
Length of e.ch trenc R. C5D
Depth of tr- the .
Size of stone
.r Tif •k ro SEEPAGE PITS: N "'.er-
Size - . x ft.
Stone size .�
PIPING: Size Type
Bldg. to Tank c65�/��
Tank to Dist. Box .502
Dist. Box to Field ' '
Openings Sealed? Y- - No Partial
LOCATION/SEPARATI$0
Foundation to Tank feet
Foundation to Absorpt'on feet . .
Separation of Pits feet
.--conforms as per Plot °1 an ACeP No
LOCATION 1 SYSTEM ONIPROPERT .
(circle . e)
Front - 'ear Left Side - Right Side
Middle Fron. - Middle Rear
COMMENTS: : .
-- tq.
SYSTEM USE APPROVED:
PP VED: 41:31 NO
Arrived:
Departed:
Building Inspector
'_ECE VER
JUN 2 5 200i
TOWN OF QUEENSSURY
BUILDING AND CODE
IQoJ qP2
J pr L
vO'
"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
<_<° . 'wn on this document. I also represent that I have
perso .Ily measured tv di ances se lorth on the diagrai
SIGNA
DATE