97-168 BUILDING PERMIT
VALUE $ 0 TOWN_ OF QUEENSBURY No. 97168
TAX MAP NO. 84 . -1-2 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to HOAG, RICHARD & MARIANNE
OWNER of property located at 11 THUNDERBIRD 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
11 THUNDERBIRD RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
HOAD, RICHARD
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
COMMONWEALTH ELECTRICAL AGENCY
5. ARCHITECT'S Address
PO BOX 706
HAGUE , NY 12836
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( ►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 April 30 1g 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 30 Day of ; April 19 97
SIGNED BY /UV 1,11n,N _e for the Town of Queensbury
Building and Zoning Inspector"
Application for SEPTIC DISPOSAL• PERMIT
Town of Queensbury Permit No. _ l(�
��
• Dept. of Community Development
/(01
Building &Codes Office U()
742 Bay Road Fee Paid OS
Queensbury, NY 12804
J
Location of property for installation: l J V/a SSrbi'rd ri l)e O C1 rq
Property Owner's Name: 110 chard 4 0111 apne f-aa9
Property Owner's Mailing Address: ne
Installer's Name:'BJ i I lh re1 ) E, W L4-fr 1c Phone #
Number of bedrooms (if residential): .13 . Total daily flow:
(residential -compute @ 150 gal./bdrm.)
Topography: Vflat, rolling, steep slope % of slope
� PC�vG� I
- Soil Nature: 1-Viand, loam, clay, R�bPidepth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: not required, required [rate min. per inch] C?7_(
, 6
..
Domestic water supply: (unicipal, well, other 4 6"1,
If domestic water supply is a WELL, water supply from any septic abso tion kpR 29
PROPOSED SYSTEM TOWS`Of(UEENS URY
BUILDING AND CODE
Septic tank:/d6 G gallon (minimum.size: 1,000 gal.)
Tile field: each trench feet / Total system length: feet
Seepage pit(s): number of 2_ I size each: ' ft. by 8 ft. •
Size of stone to be used: # / depth or thickness e feet .
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
(Marm 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 Qaeensbury, 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 Snitary Sewage Disposal Ordinance.
•
Signature of responsible person: ,ili�i 47Date:
•
TOWN OF QUEENSBURY
BUILDING 8 CODE ENFORCEMENT
531 Bay.Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 1-)64-6 II :
1
Location -,�i/4_96=e42Q 641
Date S1z3�yj P rmi t # /,/�/(r/�
SOIL TYPE: Sand-Lo.m-Clay- d
Results of Percola ion Test; .
(if applicable) Ra e-Minute%Inch
TYPE OF SYSTEM: 7
ABSORPTION FIELD: otal Length
Length of each tre ch f
Depth of trenches /
Size of stone 1'
SEEPAGE PITS: Number-'
Size - _ ft. k / ' ' ft.
Stone size \/ •
PIPING: Size Type
Bldg. to Tank P'
Ta k to Dist. Box TV
D 'st. Box to Fi el d` Pit
penings Sealed? / Yes No Partial
LOCATION/SEPARATIO : 1
Foundation to Tank \ feet
Foundation to A isorpti ,n _ feet
Separation of Vits lipeet
Conforms as pef Plot P1 an ' No
LOCATION OF SYSTEM ON PROPERTY.
(circle one)
Front - Rear .- Left Side Right Side
Middle Fro� - Middle Rea
COMMENTS: 11
( uM1 5— 8(J/L7T ,L�-n1/ GN
. >Scc- A�— gu\L c._�
SYSTEM USE APPROVED: YES NO
Arrived: t5S-7 De
parted:
Building Inspector
5-0- 0 - ,524--,e___,_
TOWN OF QUEENSBURY
BUILDING 8 CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
r-) / s';
Name ( GDP /4t66.
Location ,1 l �- 0�; '
Date ,7-3 -/ Permit # / -7/C7
SOIL TYPE: Sard-Loam-Clay-/
Results of Per olation Tet-
(if applicable Rate-Mindte/Inch
TYPE OF SYSTEM
ABSORPTION FIE D: TotalLength
Length of each trench /
Depth of trench s
Size of stone ‘ /
SEEPAGE PITS: N mber'-
Size - f . x ft.
Stone size _
PIPING: , r Size Type
Bldg. to Tank
Tank to Dist. Box GZi-1 khcn:R tom '
Dist. Box to Fiel 1/Pit
Openings Sealed? ili, Yes No Partial
LOCATION/SEPARAT DNS:
Foundation to Tank \ feet
Foundation to Abjsorption _ feet
Separation of Pets feet
Conforms as per P1 of .Plan Yes No
LOCATION OF SYSTEM PROPERTY:
(circle one)
Front - Rear -" Left Side - Right Side
Middle Front 7 Middle Rear
COMMENTS:
IIA -30 1 Ur 4e_tr\ lc_
6£ate i V E-. �C\O
/
SYSTEM USE APPROVED: YES NO
Arrived: d
Depar
B it 'ng sector
7-7,,,, d io-..', '
TOWN OF QUEENSBURY .
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name �ccJQ 06
Location
I1 61 o
Date SIg j4i Permit # q� /�-gLQ ,
SOIL TYPED San Loam ay- � E -rW
Results of Percolate . Test-
(if applicable) `at .-Minute/Inch
TYPE OF SYSTEM:
ABSORPTIi FIELD: otal Length
Length of each t_yl�
Depth of tre
Size of • one
SEEPAGE PITS: Number- A4
Size - 044 ft. x v ft. -
Stone size a 3
PIPING: vE5 Tb Size Type
Bldg. to Tank ` �
Tank to Dist. Box 1-1 " 612
Dist. Box to Field/Pit /111 4 VQ 35
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank ..5- feet
Foundation to Absorption ,�J feet
Separation of Pits 17 feet
Conforms as per Plot Plan Y- No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear eft Side Right Side
Middle Front - Middle Rear
COMMENTS: .
o E.D R 6-bo 1LT \6EPTC
0 6LE_ -\3E 1-4 " OD Pi
SYSTEM U d l To Zf �ti USE APPROVED: YES
Arrived: ()c)
Depart iiip C
..1.41 - te.l.
Aggleillill
B ilding Ins, •r
lig
, '
I, -
"I have seen et°bemired,et Move I sett widens et
all objects suet's,bees%elektiost.hem ate.,
shown on teitdoutmeat.t abe topreseet.thet I hove
personally mmiii wat**tot foga as the diagram."'
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SiGNATUR
DATE
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' .....,------- 4)2'" . •Vjc; (it A : ' RECEIVED •
MAY 221997
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BUILDING .8- , ....,-9. DEPT.
REVIEWE0 BY
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DATE .
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