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2002-939 �.� TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8 1 Community Development-Building&Codes (518) 761-82i 6 BUILDING PERMIT I Permit Number: P20020939 Application Number: A20020939 1 Tax Map No: 523400-301-012-0003-012-000-0000 r Permission is hereby granted to: IRS SF,PTIC &DRAIN i For property located at: $ HILLCREST Ave 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 Qi eensbury Zoning Ordinance. Tvne of Construction Val Owner Address: ALAN& CHERYL WEST i 5 HILLCREST Ave Septic Alteration Residential Total Value QUEENSBURY,NY, 12804 I Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications i i 2002-939 Residential septic alteration per plot plan and specifications. $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: I Thursday,INov,' er 13,2003 (If a longer period is required,an application for an extension must be made to the code Enforcement Of is er of the Town of Queensbury before the expiration date.) 1 Dated at the w f Que bu ;Xsday,November 13,200I I SIGNED BY for the Town of Queensbury. ury. 1 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: j f _.....11........................................_................._............._....._.................................._.........., JC wi /C S r ) Office Use Location of installation: /` f (� T� X 1 File Permit No. 37 Tax.Map No. Fee Paid %a Owner's Name: Address: 2. INSTALLER'S NAME PHONE NO. 3. RESIDENCE INFORMATIO_NL:_ (circle year of dwelling,indicate#bedr 6om(s) and multiply#of bedrooms with applicable gallons per bedroom 1 to equal total daily flow) Year of House: No. of Bedrooms x Computation — i To�taall Daily Flow 1980 or older 3 x 150 gal/bdrm = `� 1980— 1991 x 130 gallbdrm = E 1991 —present x 110 gallbdrin Garbage Grinder Installed yes t no i Spa or Hot Tub Installed yes_ / no NOV U 7 2002 TOWN OF QUEENSBURY 4: PARCEL INFORMATION: (circle applicable information&indicate measurements) BUILDING AND CODE a h of ture Ground Water Bedrock or Im ervi us Material ater SW ply Flat sand at wh�af depth at hat epth mu "cz a ailing am Aft-feet Lt=t Steep slope clay well;water supply _%slope other from any septic-system depth: absorption is ft. other Percolation Test: (To be completed by licensed professional engineerior 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). JAdd 250 gallons to the size of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. Septic Tank: —d gallon (min. size 1,000 gal.) �� s� a+" �`/ Tile Field: each trench�ft. Total System Length O d 3� ft. I t Seepage Pit(s): number of size of each: t. by ft�. Size of Stone to be used: # ! depth or thickness feet Bed,System Size: x Alternative System: length andlor size 6. HOLDING TANK SYSTEM: (if required) t Number of tanks: / Size of each: gallons J TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be i spected by a j own approved electrical inspection agency. 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please re!id) For your protection,please note that pursuant to Sectio i 136-29 of the Code of the Town of Queensbury,any permit or approval granted which isG 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, sh l 11 be void. I have read the regulations with respect to this application and agree to abide 1 ly these and all requirements of the To f Queensbury Sanitary Sewage Disp'sal/Ordinance. wop Signature of responsible person Datb ♦ufl Tow,2t of Qvic malmi•y 111(l Sewtipte DisImsat C:11211)It r l�I�I�cs�ttli� C i A-U-SORPTION JRI'TIC)N FIELD I 11LA'I'IL?iN ILI:CZI.Ji ILI%I1•l I':i�l'I'.4'7. • Nl— � .,r.�-, t ����tflSiiltt•tt rxyt,csrLx�3 'A • I ':, ;�c•QA'�. +,�}'t3P1`.i L1'.+2"ns�vt.�s \yavn -•' .. 7. 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