2002-830 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&.Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20020830 Application Number: A20020830
Tax Map No: 523400-302-018-0002-030-000-0000
Permission is hereby granted to: SANITARY SF,WF,R
For property located at: 7 BAIWER Ave
in the Town of Queensbury,to construct or`
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. Tvue of Construction Value
Owner Address: EDNA HAYNER LE
JOYCE' MINTZ& JOAN.NICHOLS. Septic Alteration Residential
Total Value
7 BARBER-Ave
QUEENSBURY;NY 12804
Contractor or Builder's Name,/Address ! ;f''Y `'? '` i", Electrical Inspection Agency
Plans&Specifications i
2002-830
Residential septic alteration per plot plan and specifications.
$25.00 PERMIT.FEE PAID THIS PERMI+EXPIRES: Thursday,October 02,2003
(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 n o eens , esda , October 02,2002
for the Town ofQueensbury. r ,
SIGNED BY r�,�,
Director'of Building&Code Enforcement
5 `
516 *745::4437.
FILE No.638 04.,,02 '02 AM"`ll:25.?ID:TOWN OF QUEENSBURY FAX:518. 745 '4437 PAGE 1
Application for Permit.-"Septici Disposal System -
?'oH+n,gf Quee»sbury.74?Bay Road QUe nsbuiy.NY 128t14 {3l8) 761-833¢
1... :a u. ,...__.
l. OWNER INFORMATION: (JKICE Use c�sr
Location of installation: t✓611-3 2- AV41
Fite Permit No
Tax Map No. 77.
t NQ` NI�� Fee Paid
Owner's Name: _.
Address:
2. INSTALLER'S NAME 7v°1^,Z. Q(;eleset. PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total dailyflow)
Year of House No.of Bj2drooms_ Total Daily Flovsr i� �'OVED
.
1980 or older . t .150 1/bdrm
_
1980-1991 x 130 8 1lbdrm OCT Q 1 2002
1991 -present x 110 gallbdrm
a 3arbage'Grinder Installed yes— / no TOWN OF QUEENSSURY
Spa or Whirlpool Installed yes_ J no -4j-- F.1_!4`P!11f03 N!'D ;ODE
4, PARCEL'INFORMATION: (circle applicable information 8c indicate measurements)
Flat $a at what depth at what depth t
v ng ctfiii,,. feet ,first
Steep slope clay,: lf"Well. water suPP1Y
-%slope ether from any septic-system
depth: absorption is ft•
other
Parcoludon Teat: (To be completed by licensed professional engineer or architect)
Rate: _minute per,inch
S.- PROPOSED SYSTEM; trtzetion: All individual mewege disposal systems must be designed by wlicensed
professional engineer or araWu.sct(unless-installed in a Planning Board appavved subdivision). Add 230 galloxu tc+the size
of the wpdc tank and leach �d fbr each arbage ChInder.Spa or Whirlpool Tub.-
V,/j a
Septic Tank:' �Q gallon(min. size 1.000 gal.)
Tile Field; each trench fl. Total System Length:
Seepage•Pit(s): number of size of each: , fi by �.
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
A t6mative SyateM.: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /TOTAL Capacity: gallon:
Note: 'Alarm System and associated electrical work xhuct'bo inspected by a Town approved
electrical iinspeotioax agency.
7. SIONATURE aTt INFORMATION FOR RESPONSIBLE PERSON(please read).
For your protection,please note that pursuant to Section 136-29 ofthe Code of the Town
of Queenabury,anypenrnit or approval granted•which is based upon or is granted in
reliance upon any material misrepresentation or failure to snake a material fact or
oircuatsta nco.known by or on behalf of an applicant, shall be void.
I have read a segu ations with romp to this application and agree to abida by these and all
requirem the own of Queens. Sanitary swage Disposal Ordinance.
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TOWN OF QUEENSEURY
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