97-735 BUILDING PERMIT
TOWN OF QUEENSBURY No.
VALUE .. S 0 97735 ,;
= . TAX. MAP' 0 =-- 17.-11-5 WARREN COUNTY; NEW YORK„
t1 � - a -
�
PERMISSIO is here y granted to GRIGSBY. .CHRISTI/1E/D'I'SHuN
OWNER of property located at 3 LUZERNE RD. Street,Road or Ave.
in the Town of.Oueensbury,To Construct or place a pp
at the above-location in accordance to application together with plot plans-a l{erinformation hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
;::. 1 LUZERNE- ROAD
'._....,QUEENSBURY - NY,,,,. 12804
2. CONTRACTOR or BUILDERS Name i
-1,.,-1.B:S,; SEPTIC,,,,, .::..
3. CONTRACTOR or BUILDERS Address
r -2i:.LOWER:, WARREN STREET
atrsr.:.Q,U2ENS8URY .,:NY .,12804
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction-(Please indicate by X)
S�T TI.0.... ..
1 )Wood Frame ( I Masonry ( ')Steel
7. PLANS and Specifications .
_: .=SEPf C :=ALTERATION:-:AS. PER PLOT PLAN-;SPECIEICATIONS.,�s�...fi�
1 8. Proposed Use
i
4- o-SEPTICIAL-TERATSOIL.,.
F},
,
$ PEtutil1' F'EE"PAID =THIS PERMIT EXPIRES January- 51g 0:,::04, f�
(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.)
i
Dated at the Town of Queensbury this
SIGNED BY / for the Town of Queensbury
Building and Zoning Inspector . .
Application for SEPTIC DISPOSAL PERMIT .
r
Town of Queensbury
Dept. of Community Development Permit No. hr;
Building &Codes Office
742 Bay Road Fee Paid $
Queensbury, NY 12804
J
Location of property for installation: ( C.1 Z P /' /► . r c)
Property Owner's Name: Cift."/ 57`<C1. 1 /S 4, \I ?" ii-- -.
Property Owner's Mailing Address: /
Installer's Name: ,4 i /), f. 42 i < Phone # 72T- 77 y
Number of bedrooms (if residential): 7_,.._ Total daily flow: 3 b- .;;
(residential - compute @5 Uglb—d ai a. _
Topography: rflat, rolling, steep slope % of slope DEC 17 1997
Soil Nature: sand, loam, clay, other /depth: T " ' ---..i,
Ground water: at what depth?M feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: ot 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 feet. .
PROPOSED SYSTEM
• I
Septic tank/Dog gallon (minimum size: 1,000 gal.)
Tile field: each trench feet / Total system length: feet
Seepage pit(s): number of / size each: r ft. by ..5--- ft.
Size of stone to be used: # / depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: _ gallons
G.klarm 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 ,�
of responsibleperson: Date: . U r77
Signature po � ��
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road it ein.Queensbury NY 12804 1
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name (::Wry)(3-1(1.
Location
Date ) "q Permit #q-7--7, c_ ,
SOIL TYPE: l.r2,K
Results of Percolat' .- Test-
(if applicable Rare-Mi 'ute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELr. otal ength
Length of each• tr- ; ch
Depth of trenches
Size of stone
SEEPAGE PITS: Numb-r- -�
Size - ft. x CB ft.
Stone size 3
PIPING: Size Type
Bldg. to Tank 1 0. 6 _
4,
Tank to Dist. Box WV
Dist. Box to Fit/Pit kAtt
Openings Sealed? No Partial
LOCATION/SEPARATIONS:
Foundation to Tank 1C feet
Foundation to Absorption feet
Separation of Pits .2-14
f et
Conforms as per Plot Plan Yes NON.
LOCATION OF SYSTEM ON PROPERTY:
(circle
Front -(M Left Side - Side '
Middle Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YES 0
Arrive . --
Depa
Buildi g I Spector
•• .•...•.•. 1:i...u.u.u....::: ....uC:: CE .■...E ■ ""...i■■■..■■■■C■..■■.u■.■.ii■■.■■.■■..u■EE •_
- . .■.... . _ ........... ..■...CC. .. . E. EC:::: .u.......u.u:CEEEEEE.EEE:E'E:.. .....'.......... .
--C: :::CEE:: ' . •..•m•:EEEE:••••• E:E::ECEE E:C:C:::: u...uuu...u... ........ . •.uum:E .C:
.uuuuC:..::: '::::::: . :::::::• •••• •• • ....... ...... ....... ........ , . ....■ ..■
• C C■■.■■■.. .......0 ■.. .■.. .....E.... ..■ .■■..... ...
_EE...E�:' . :::�:.::::::::E::�•.:::E::::::::...E:::�::::::::::E::: . :::C:::C C::
.. a:..:. .i, ....C::.......... ........:.........C.............. ....... ■
■■ •(11i1
.■ ■.■ ...■■ ■.■ ■ ■ ■■.■.. ■ ...■.■■■■ ... .■ ..■. ' ' , }� ■■■ ■■■ .■
. a-� ■. '�---'�.. :UW: ':' :CE:�E::C:::::gE...�::..:�... , ■..:... ..E■■ ra■ ■■ ■i ii...■ F ■ ... .■■■■ ■.■ _, ■■■■.■■ ■■■■.■■■■■. .■ .■ ■■■■■■■■■ ■■ ■ •� .■.....■. ■■■■■■.■■ .■■■ .■■■■■. .■......... .. ..:■....■■... ■■■ .. ... .0..................:.... I -_ . ....... E...
..■■■■■ = ■ ...■.■■■■■■■■ ■■■■■■■....■■■■■■■■■ ■.■..■■■■■■■■■...■..■ 5 , .■■■■■N ■■■
.■■■■■...■ .......■■ ■■■■■ ■ ■■■■■..■.■...■■■■. ■. ■..■■■ ■■■■■■..■■■■■ wji
■ ; ■.■■.■■ ■■.■
. .■...E.... •••CC•CC•C•:'• :E.E■E... ........E... .E■..■E......C..CC.■ ' 1A r
_rm.,.. E ■...... ...
u..u.•...::.: .....C..:C:.... EC: ' 'C'EE::::::::■:::. •..u.••.....m•u•.. •. C •uu.u.: ...
-_u..:•:::C:::: :'C:::u.u.u.::. ".. . ... ... ... C::. ::•••"C•••••••■■• ' ' ! ••• •• ::C:C ..
■■■■■ .■■■■ .■■, ,; ■■ ■ ■■•u....mm....: ........u....... •.. :: ':o m•• :C•' ■...........C:... - J. j
.E ; ...
■■■■■■...■.■. ..■■■■.■ .■.... ■.. ■■ C■ ■- ..■ ..■.. ■..■■.■■■■■ ■■ i ■■.■....:C::�:EMCEE: ::.EEM...EE..... E� , ..: C ... .... . ■.■�■.....:C.E ......_
■.■ ■ ■■■ ■■..■ ■ , ■■. ■■■ ■■.■.. ■■ ■■...■■. ■■ Jill .
.■■■■. ■■u■. ■.■ ■■■■ .■■ ■ ■ ...■ _ ■ f; ■■ ■ .■■ ■■.■■.. .. ■..■ ■■■ ■ ■■■.■ ■:E u.
EE... . ........:E..:... ... •• . ....... ......:_...:.. ........■ ■ ■..■■■ ■■■■■■■■■ .■■■.. .■.. l i ■ ■� .■■ ■■ ..... ■■■■■.. .■. .. . - 1- = ■u.•...■...■..■■■ .■■■■■■■■■.■.■.■ ■■■■ ■■■ ■ .■■ ■.■.■.0 ■■..■.u■ ■■ r i ' ' -- .■■■■.0 Eli...■. :, .. ■ ■■■ ■.■■■■.= ■■■■■■..■ , .._ r r- ■■■■■■■■ ■
........... . ........E.... ... 1 • ... ......... ■■... ... ! �F-v_ ........ ..gau•.u..mmu.. ........u.u. mm. um '.': 'al u......... '.u.u..m.. I ,=G _ - _ :uumuu.. :
_mum:...:.. .....mumm...... u...... ......... ......... - — ..... ..
. ........... ..■■■■.■u.. .■.■...■■. ■.■. ■.■■■ P. ■..■■u 1 _
...C. ... .. TIE.. ■_ .� .. ■..- :. 141111111 ..... .. i ........... lfk 4r1_ ....... .
:" C::: : ..EEE •- Nu C EHu� - ....1• E: ••: mu..:: :::: --z-i�°- MINN__
■■■■ ■ - 3 _ 1 ■■■ ■■■■ .:■ ■ : ■■ ■. .■.■■■ �IIN:NIHhIE'it : ..:.. . . . . :. . . : : ` .... :■ ■ ■■■: _ :■ : ■: :■ ■ ■ . ■■.■■■
. E �. .. ..E . : . mm.. . .E i. .■... I'T
. C : . CE:CC �. :: -i _Q ... ... :. E.C...... , ..E: a ■■.■■
_C:.. E u■■ ■.■. ■ ■■■■ .u.1'—■■■■\ u. ■■■ ■u■ .■. ■.■■■ ■■m _ C
...C■■■i ■■■. umuu':CC■■■■:■.■ ■■■■.■:■ --.■ .. ■ J u■ ■■■u. _ ■.. 'I fl
EIJ:::::::::u..u..uu.u.muu......• • •• " E ! ...
EEE EEE141111117111111111111111111111
: . ..:... .... - _ - � . . ■- --. lia.. simm ... . .. . . .... ....... Ep. un.• . �. . - .0 E :.:..: ...C:. _4 . • .............: .... . ........ ■ .... ® .. - •E E..-- - 1
m OM-MU.m mu :. '..mmuu:::'::::::CC.uu..C:::::::: :: _ `�u.... •m. -M '. •:':•: ::::::::•:::C
.. ....:....:....E.:.. 'C.EE.......E .E , ..E. u.CE. .:EE. .........EE......E 4-
■ I — • ■...■. ■ ■u. ■..■■.■ ■ ■. ■ .■■■ .■ ■ uu■■..■ ■■■■■.■ _ a
:CCCCC:C' •. '. ■.E'EE'E �-�- EE'•-` EE:EEEE: mmm mum_. ._ ': : d mm mm m m mm :m=mom
........:. :. .. . . .. - :- .. .... E.E ..... ....:EEEE......:..
........... ...... ....� ... - ... . .■.....0 .■:�3.... . .. ' .... .. . ........■■.. I-
■■.■.■■■■■■■■■■ ■■■.■.:■■■■I e.■ .. ..■■■■■■■ ■■ i■■■■. .. ■..■■ ■■■■ ■uuu■■■■■■■■■.■■.■
■.■■......■■. ■ .■■■..■.0 ■■. ®.■ ■ .■■u■■■. ■■■ ■■■■_ .■■■■■■■■.. ■■. ■■■■.■■..■■■■ i
.. ....E.....: ..■...■■.■.E�.E. ... ,c- . I ........ ......■■:: .. ' m........mm :::C::::E::':C::::
. .... .... ........... ..� 4• ...... .......
- ■ ■■■.■■■■.0 .E■■■■■■ I : T_ • •. :■■.■.■Ei ..■ ■� ■■■■■. ■.... . .■■■■■■.■■■:■■■..■
E• •••••.....■ '- . .....■ I` . c ME ■■■■.. ■.■ .....■...m■.....
EEEEEEEEEE'EEE EEEE'EECE 6. k °'E E . EEEEEEE ::::m....................................... „,
............... ....:..:. .■ i ..... n............................................... . ...-
.0.............. ............... ii....... .=..u�..E u...�.. EE u..........■.Em•m■Eu.:::EEEECC:�:::
1111111111111111
E■■■■=■■.■ .■ ■■u■■■■ 0�::::': ■h■■��■�.��.. ■■�i e■ ■■.■ ■i■ ■:C:•:: :•::: ■ ■■.■ ■ ■■■■ ■■■-
C: ::: ::: :C : ::: .. E EEE..EE.EECE:E.•:CEE C�EEEEC::E :•E:SEC ECE:::CCCEE=m uC:C'C::::C•• -
.: C. CE EE. ■.. . ..... .
-CCC■■:■....u...: .■■C. C.u.■.■E..........:. ...................:................■.....:...CC.......C.
■ ■ ■■.■■■ ■■ ■■■■■..... ■■■. ■ ..-■.■E■■■■.■■ ■■.■■. I ■..■.■■■■u■.■■■■ H .■■■.u..0 m•