98-101 TOWN OF QU'E'ENSOURY
WARREN COUNTY . NEW YORK
Da to 19 ---38
This is to Certify that work requested to be done as shown by Permit No * -� -
has been completed .
SEPTIC ALTERATION
This structure may be used as a
Location 10v AN& CHESTNUT RIDGE RD
Owner CAR STEN S , GARY
By Order of Town Board
TAX MAP NO . 54 . - 2 - 8 . 1 T OWN OF MJ SBU Ry
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 98101
TAX MAP NIA . 54 . — 2 - 8 % 1 WARREN COUNTY, NEW YORK
PERMISSION! is hereby granted to CARSTENS r GARY
OWNER of property located at 107 CHESTNUT RIDGE RD . 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
107 CHESTNUT RIDGE ROAD
QUEENSHURYr NY 12804
2. CONTRACTOR or SUI LIDE R'S Name
CONTAX CONSTRUCTION
rGLENS
=FALLSo
ER'S Address
Y 12801
ARCHITECT'S Name
5. ARCIAITECT'S Address
6. TYPE of Construction — (Please indicate by X) SEPTIC
l 1 wood Frame ( I Masonry It ) Steel I l
7. PLANS and Specifications
SEPTA ALTERATION AS PER PLOT PLAN SPECIFICATIONS
a. Proposed Use
SEPTIC ALTERATION
April 1 2000
25 PERMIT FEE PAID — THIS PERMIT EXPIRES 19
$ {If a longer period is required an spplicetion for an e
xtension must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date.}
1 April
19
Dated at the Town of Queensbury this
Day of 19
for the Town of Oueensbury
SIGNED BY
ftui ing a Zonirq lntprecor
Application for SEPTIC DISPOSAE PERMIT
Town of Queensbury Permit No.
Dept_ of Community Development
Building & Codes Office Fee Paid Cad
742 Bay Road
Queensbury, NY 12SO4
_� .
Location of property for installation: 4:�� APR 01
Property Owner's Name: �r`7'�r� � Tc]Wv OF
GGDE
Property Owner's Mailing Address:
Installer's Name: c --� r. i.� Phone
Number of bedrooms (if residential): ! � Total daily flow: .j 2
(residential - compute 0 150 gal.fbdrm.)
Topography: flat„ Xrollingl steep slope % of slope
Soil Mature: sand, --)� loam, clay, other I depth:
Ground water: at what depth? feet 1 Bedrock or Impervious Material: at what depth? . feet
Percolation test: not required, required I rate min, per inch ]
Domestic water supply: municipal„ well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSER SYSTEM
Septic tasnl¢,,%�Gc� gallon (minimum size: 1 ,COO gal,)
Tile field: each trench feet f Total system length: 360 feet
Seepage pit(s): number of 1 size each: ft. by ft.
Size of stone to be used: # eLl / depth or thickness t feet
14OLDE TG TANK SYSTEM: (if required)
Number of tanks: / "� Size of each: 1, �i gallons
.Alarm system and associated electrical work to be inspected by a certi£ted agency.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town oe Queeuabury, anY Permit or
niarion or failure to make s
approval granted .which is based upon or is granted in reliance upon. any material misrelxes
material fact or circumstance known by or on bebalf of an applicant, shall be void.
I have read the regulation with respect to this application and agree to abide by these and all requirements of the 'Town of
Queensbury Sanitary Sawage Disposal prdinance.
/7� / �_. �� / c
Signature of responsible person: � Date:,� �/� " /-��-.-��"�
TOWN OF QUEEMSBURY �
BUILDING & CODE ENFORCEMENT
742 Say Road
Queensbury MY 12804
(s►s) *761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ----
Location
Date (!Ef L4-1 ' 'i?Perini t #�
SOIL TYPE: SandirLo6nioClay-
Resul is of Percolation Test-
( if applicable ) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD . T al ength 34
Length of each tr h
Depth of trenches - 2.
Size of stone
SEEPAGEPITS : N er-
j Size - ft x ft .
Stone size
PIPING: Size `fype�
Bldg . to Tank � ^
Tank. to Dist . Sox
Dist . Box to Field/P ' F•
Openings Sealed ? es No artia
LOCATION/SEPARATIONS : �
Foundation to Tank A4%, _ feet
Foundation to Absorption feet
Separation of Pits i- eet
Conforms as per Plot Plan es No
LOCATION OF SYSTEM ON PROPERT
( circle o
Front a p« Si - Right Side
Middle a Rear
COMMENTS :
SYSTEM USE APPROVED: ES NO
Arrived :
Dep a rted w
7din� g nspector
TOWN OF QiUEENSBURY
BUILDING A CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date f" Permit #
SOIL TYPE : Sand- Loam- Clay-
Results of Percolation Test-
( if applicable ) Rate-Minute/ Inch
TYPE OF SYSTEM:
ABSORPTION FIELD : Total Length
Length of each trench
Depth of trenches
Size of stone ----�
SEEPAGE PITS : Nunnx r-
Size - f ft —
Stone size
PIPING : Size Type
Bldg . to Tank
Tank to Dist . Box
Dist . Box to Field/Pit
Openings Sealed ? Yes No aartial
LOCATION/SEPARATIONS :
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY :
( circle one )
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS :
r 2l /na` rN
SYSTEM USE APPROVED: YES No
Arrived :
Departed :
Buil di ng inspector
CHESTNUT RIDGE
a
325
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