97-177 BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 0 No. 97177
TAX MAP NO. 50 . -1-5 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to KUBRICKY, R-IC}FARD &
OWNER of property located at 24 HEWITT 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.'O WNE R'S Address is
DOROTHY 24 HEWITT RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
KUBRICKY, RICHARD
3. CONTRACTOR or BUILDERS Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SSEPTIC
( )Wood Frame ( 1 Masonry ( I 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 12 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 Oueensbury before the expiration date.)
Dated at the Town of Queens 's 1 bay of May 19 97
SIGNED BY „ A:L for the Town of Queensbury
Building and Zon ng nspector
L. Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept. of Community Development Permit No. ' '
Building &Codes Office P F(.F (F .1(-69
742 Bay Road Paid $
Queensbury, NY 12804 APR 4`97
_
TOWN Of A �i a_ tJRY
Location of property for installation: 29 L./Z� ' e;i.1 o<« ?,%� "/,
Property Owner's Name:
Property Owner's Mailing Address:
Installer's Name: � �T Phone #
Number of bedrooms (if residential): 5/ Total daily flow:
(residential - com e @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope f slope
Soil Nature: s.,•d, loam, clay, er /depth:
Ground water: at what depr? feet / Bedrock . Impervious Material: at t th? feet
Percolation test: requir-• r ed [rate </inch]
Domestic water supply: municipal, ell, oth
If domestic water supply is a WELL, ,ater sus• from any septic abso ' n is 1 feet
PROPOSED SYSTEM
I•z5o .
Septic tank: / on (minimum size: 1,000 gal.)
Tile field: each -nch feet / Total system length: feet
Seepage pit(s . number of . / size each: J' ft. by P ft.
Size of/one to be used: # 2- / depth or thickness feet-
/ /2 7 ci, ,gerr #/ /ems%> d/%G.d.,
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
(Alarm 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 failure 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
Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: Date: L,/5:7
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No.
Dept. of Community Development
Building &Codes Office
742 Bay Road Fee Paid $
Queensbury, NY 12804
Location of property for installation: ZL ‘A-Ft 1> P
Property Owner's Name: It p,D ‘Ao k-2,FA K
Property Owner's Mailing Address: 61r111-fr►E
Installer's Name: fj fA IN1 F. Phone # 7 cr2)4)9; 7
Number of bedrooms (if residential): tic, Total daily flow: 9(DC)
(residential -compute @ 150 gal./bdrm.)
Topography: ,--"tat, steep slope % of slope
Soil Nature: l sand, loam, clay, other /depth:
Ground water: at what depth? 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 %CAM feet.
PROPOSED SYSTEM
or`
Septic tank: '7 5gallon (minimum size: 1,000 gal.)
(7) ( Tile field: each tren / t feet / Total system leng4 77 feet '1 0 AU 4
Seepage pit(s): number of / size each: by ft.
Size of stone to be used: # / depth or thickness
•
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
(Alarm system and associated electrical Rork 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 failure 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
Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: Date:
4P7LL's
TO OF QUEENSBURY ;
BUILDING & CODE ENFORCEMENT'
.31 Bay Road
Que,nsbury NY 12804
518-745-4447
SEPTIC DIS'OSAL SYSTEM INSPECTIOIgi .
1// i
Name ei my 6 ---ia rd. ,Jr,-0 % --(1)/
Location 0 �l "• 1 ►i- �$i)
Date �`;i, Permit #
r f J77
SOIL TYPE: .nd-' oam-Clay-
1
Results o' Percolation Te -
(if applicab e) Rate-Minu a/Inch
TYPE OF SYST:11:
ABSORPTION F ELD: Total ength
Length of eac trench 27
Depth of tren hes
Size of stone 2—
SEEPAGE PITS: Number _
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Bo
Dist. Box to Fie d P \ 1ROWC9
Openings Sealed? No Partial
LOCATION/SEPARATIgN'
Foundation to Ta feet
Foundation to Ab .o ption feet
Separation of Pi s feet
Conforms as per Pl o► P1 an 4 No
LOCATION OF SY :EM s. PROPER '�`�!
' ,.. one)
ront - Rear - Left S de - Right Side
- ':. e Front Middle 'ear
COMMENTS:
ti2i1 I- - of (101/612
•
5;J /ak
5%o MM %) mat)o 10, 4 \ c .ii i'
P,2r�
SYSTEM USE APPROVED: YES NO
Arrived: /' : 65.--
Departed: // :$ )
f,
Building Inspector
TOW OF QUEENSBURY
BUILDING & CODE ENFORCEMENT .
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name K )ORte=kU
Location }}�.t0 iT 62 . . .
Date 6 /�7 Permit # q7" ( 7 .7
SOIL TYPE: Sand-Loam-Clay-
Results of Percolat'on st-
(if applicable) Rat -W nute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: T al Length
Length of each tr c ;
Depth of trench s
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: .
•
SYSTEM USE APPROVED: YES
Arrived: f 0,
Departed: a . !)
Building Inspector
? 3e7
-'= TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ilu/ejel.G0)
Locati ln r)C I�I /'
Date 4I/47 Permit # 9j-/77
SOIL TYPE: Sand-L am-Clay-
Results of Percola io est-
(if applicable) Rat inute/Inch
TYPE OF SYSTEM:
ABSORPTION FIEL . To al Length
Length of eac., trench
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:
t ,a— C116-6K ' 1 ) %6Ti1
gte- /;, ov
SYSTEM USE APPROVED: YES NO
Arrived: iff447
- ��
Departed:
i�Ee
Building Inspector :
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name . *ft -At . it
Locatio _ 1
Date `�j 1 '0-7 Permit #G r t
SOIL TYP : Sand-Loam-Clay-
Results o Percolation Test-
(if applic.ble) Rate-Minute/I h
TYPE OF SY 1 EM:
ABSORPTION :' IELD: Total Length
Length of each trench
Depth of tre hes
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank l'r _______
Tank to Dist. Bo
Dist. Box to Firld Pit
Openings Sealeg? Yes No Partial
LOCATION/SEPA' ,TION •
Foundation to Tank feet
Foundation o Absorption feet
Separation of Pits _ feet
Conforms is per Plot Pl .n Yes No
LOCATION OF SYSTEM ON PRePERTY:
(circle one)
Front Rear - Left Side - Right Side
Middle Front - Middle Rear
COMM''TS:
EEO t o P.�v o .E- ABC
1___IbCD,i 4.
SYSTEM USE APPROVE D: ES 0
Arrive.. I tow
1
____
Depa ,'ed: Q ��
-.-il-mir".4(41A. f/iot_
B 1 .i ng Insp fto
1`\
TOMB OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC D POSAL SYSTEM INSPECTION
Name NA 1A,,k7wlev4
Location 7i4 VrEt.0D en
Date -- --'*1 Permit # E 1
SOIL TYPE: San.-Loam-Clay-
Results of Percolation Test-
(if applicable) 'ate-Minut- Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total ength
Length of each tre ch
Depth of trenches
Size of stone
SEEPAGE PITS: Numbr -
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to F eld/Pit
Openings Sealed? Yes o Partial
LOCATI ON/SEP A 'a TI ONS:
Foundation • Tank feet
Foundation o Absorption feet
Separation of Pits _ feet
Conforms a. per Plot Plan es No
LOCATION IF SYSTEM ON PROPERTY:
(circle o e)
Front - Rear - Left Side - Right ide
Middle F ont - Middle Rear
COMMENTS:
£ i2=ate c
SYSTEM USE APPROVED: YE ,O
Arri • ; ,
Of'
, Ir: .,.. .11 FE4Pr ii'
Bui din', Inspector
a •
`�
�_!4 " TONN OF QUEENSBURY
.' - BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name Vinp)R ICIM
Location I ' L _v a
'a e (51 1 e 1 Permit # '`7-177
SOIL TYP
�
-Loam-Clay-
Resul
ts of •ercolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: i
ABSORPTION FIELD: Total L,engtli /�DC)
Length of each trench I (,pO'
Depth of trenches '".
Size of stone er i�
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank _*i_. /0
Tank to Dist. Box __V.„1
Dist. Box to Field/P • , '
Openings Sealed? No Partial
LOCATION/SEPARATION
Foundation to Tank ___K2. feet
Foundation to Absorption feet
Separation of Pits _ eet
onforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPERT .
(circle
Front Rear - Left Side - Right Side
Middle ' .• - Middle Rear
COMMENTS: 2.— l 'iD MiTt-tA
>c..,
S 6- A 5 _'-j c>i I,I" V L,A ti) at) c_
cprLL -ID02 ReCREGV op TUv„.V)
C 10 C oczY . 7 5—&kAii
SYSTEM USE APPROVED: il
NO
Arrived: g 'JD
Departed: '
Building Inspector
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•• RECEIVED
• 1 MAY 12 y .
TOWN OF OUEENWURY • j
y '. BUILDING AND CODE f ?'
o •
MAY tl: 97
"I have seen or observed, or believe I saw evidence of, . TOW' 'I AND CO11Y N
all iooiects such as houses, wells,,trees, fences, etc., - ��oIN�AND a► 'Q
an this document. f also represent that I have •N41 c
. petaunally measured th ' tances set forth on the diagram." �;4.
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