97-182 BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No.
971,12
TAX MAP NO. 137 . -1-4. 1 WARREN COUNTY, NEW YORK
PERMISSI i ereb eri
y granted to CONSTANTINO. JORGE
OWNER of property located at HUDSON RIVER.ON 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
END OF EAGAN ROAD
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
VEYSEY, WES
3. CONTRACTOR or BUILDER'S Address
61 MACARTHUR DRIVE
GLENS FALLS, NY 12801
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
Sf TIC
( ►Wood Frame ( 1 Masonry ( )Steel
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES May 2 19_ 99
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 2 Day of May 19 97
SIGNED BY GLO-ei c for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
/ , Q� l
Town of Queensbury 'IF/I/P Permit No. /7'! g�`
Dept. of Community Development "�"
Building &Codes Office MA� 01
742 Bay Road T®��f POW Fee Paid
Queensbury, NY 12804 BUII.DIN oF Q eeL Jdu�Y
Y.
AAID.CODE� --/ J
Location of property for installation: /3 " /e / •/(iQ- ;; eOI)
Property Owner's Name: Of. P% `IUY�^�2, �Gn v�/1 f/'i91�
Property Owner's Mailing Address: f//%/ArW rL ,%%e. iJ'q�lY 'IVY
Installer's Name: &A. Dbt 14 r/Dn&nr EXC ✓40,Phone # 79 — 7 7
Number of bedrooms (if residential): .3 Total daily flow: ;S.---0
(residential - compute @ 150 gal./bdrm.)
Topography: flat, k rolling, steep slope % of slope
Soil Nature: N sand, loam, clay, other /depth:
Ground water: at what depth?2-$feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: not required, required [rate min. per inch]
Domestic water supply: municipal, )( well, other
If domestic water supply is a WELL, water supply from any septic absorption is ,K;( feet. .
PROPOSED SYSTEM
Septic tank: gallon (minimum.size: 1,000 gal.)
Tile field: each trench feet / Total system length: feet '
Seepage pit(s): number of / size each: ft. by ft. •
Size of stone to be used: # / depth or thickness feet .
HOLDING TANK SYSTEM: (if required) �7
Number of tanks: Size of each: -3"--0 / gallons
Cetlarm system and associated electrical work to be inspected by a certified agency.)
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 figure 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
Queensbmy Sanitary Sewage Disposal Ordinance. z/
Signature of responsible person: ..4.......4
�- 7/ Date: i
TOWN OF QUEENSBURY
- " BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name C3NS%g4J TM/o
Locati on 46,¢/J 'QM' .
Date loh f 7 Permit # 77— /62- -
SOIL TYPE: Sand-Loam-Clay-
Resul is of Perco a . • Test-
(if applicable) ' . - .Test-
(if
TYPE OF SYSTEM:
ABSORPTION FIELD: T. . Length
Length of each: trenc
Depth of trenches
Size of stone
SEEPAGE PITS: Number
Size - ft. x ft.
Stone size
PIPING: Size . Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes . No Partial
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
5G-6 C'S`('vzi&; cc.cP.
SYSTEM USE APPROVED: YES I.
Arrived: /0.. ,SJ; '�
Departed: /U 5
ail---�
Building Inspector
t TOWN OF QUEENSBURY �J n
BUILDING & CODE ENFORCEMENT
742 Bay Road y
Queensbury NY 12804 (/�
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ,_c\-Tv, ,�,
Location (' A v K l
.Dates() —et7Permit # ' `._
SOIL TYPE: Sand-Loam-Clay- -6 /ea
Results of Percolation T st-
(if applicable) ate- inu a/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: ngth
Length of each trench
Depth of tren Iles
Size of stone
SEEPAGE PITS: umber-
Size - ft. x ft.
Stone siz
PIPING: 1,5-�1 �.� p; ize Type
Bldg. to Tan ®`6(Ak
Tank to Dist. Box
-Dist. Box to Field/Pit ---
Openings Sealed? No Partial
LOCATION/SEPARATIONS:
Foundation to Tank (°7 _ feet
Foundation to Absorption - 'feet .
Separation of Pits _ feet
Conforms as per Plot Plan Yeses
LOCATION OF SYSTEM ON PROPERTY.:
(circle one)
Front - Rear - Left Side - Right Side
C. idsil-e--Front)- Middle Rear , x.
O ENTS:
:(' Aat:let.--
-\-% ,
rp - �
•
,..
, .
,2
c:, .. e
��
SYSTEM USE APPROVED: YES (0 �C�
Arrived: kj,
Dena
Building I s ctor
793-8307
WESLEY C . VEYSEY
BUILDING CONTRACTOR
Remodeling — Additions L / UR DRIVE
New Construction / - C/ o L rALLS, N.Y. 12801
•
MAY Q . 1997
TOWN OF WEENS3URy
13UId_ING AND CODE
(
we ; Nes i0K (A1/1 \
Or Q JD
�d l4 V >
t Go i S'�
23'
' I — Via° b 1 ,I/ ,
. Tah,1k C/
ck
G 1A/c4 -
. K
,..
,...,
_.....t
) 5- ,
') .
"I have seen or observed, or believe I saw evidence of,
all obje is such as houses, wells, trees, fences, etc.,
' shownr nn this document. I also represent that I have
person:fly measured the dist.nces set forth on the iagra ."
A 6;
•IGNATURE / - D
.)'J . ; �� ..ter