BOTH-000346-2016 CD
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,ax TOWN OF QUEEN BURY
742 Bay Load, Queensbury,NY 12804-5904 (518)761-8201
Community Development - Building & Codes (51.8) 761-8256
BUILDING PERMIT
Permit Number: B, T14-000346-2016
Tax Map No: 302.18-2-40
Permission is hereby granted to: ML Contracting
For property located at: 127 GRANT AVE
In the Town of Queensbury,to construct or place at the above location in accordance with application together
with plot plans and other information hereto tiled and approved and in compliance with the NYS Uniform
Building Codes and the Queensbury Zoning Ordinance
ape of Construction
Owner Name: Pamela Casey Septic Disposal $0.00
Owner Address: 12.7 Grant AVE "Intal Value $0.00
Queensbury,NY 12.804
Contractor or Builder's Name J Address Electrical Inspection Agency
ML Contracting.
34 Warren.LN
Queensbury,NY 12804
Plans& Specifications
Septic Alteration to leach field only
40.00 PERMIT FEE PAID -THIS PERM]T EXPIRES: Thursday,June 1, 2017
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of'the Town of Queensbury before the expiration date.)
Gated at the TownQuee riry; WMo lie 6 2016.
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC 1 SP �ALl " :� ;, Office use Only
p " ... Received
DATE: �3w Tax Iwo CD z.
Map
° Ax MAP ID: � '. , ?ermtl nlo.
'CMbIE. I c '"KiR r r t c U ermit Fee
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k B VVI I fol�� ""
APPLICANT 1/ � g PHONE/E-MAIL
ADDRESS
INSTALLER/ Ph C?�^E/E-MAIL
�r u
BUILDER 4 yr e o Via elt
OWNER
ADDRESS
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: "`''✓�
PHONE/E-MAIL
. .;�"�
RESIDENCE INFORMATION
Year Built #of bedrooms X gallons per bedroom -total Daily flow
1980 or alder Z Garbage grinder installed —Yes 2No
1981-1991 Spa or Bot Tub installed _Yes No
1992-Present
PARCEL INFORMATION
Topography A" Flat rolling Steep slope %Slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth:
Bedrock/Impervious material At what depth:
Domestic Water Supply —Municipal "'Fell(if well,water supply from any septic system absorption is_ft.)
Percolation Test Rate: per minute per inch(test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank size gallons(min.size 1,000 gallons,add 250 gallons to size for each garbage cylinder or spa or hot tub
System Absorption field with 42 stone Total length ) 2--e) f1.;Each Trench 30
Seepage Pit with#3 stone Bow many: ;Size
Alternative'System Bed or other type:,
Bolding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will
no longer allow systems to be covered until such time as an As-Built plan is received&approved. The installed system must match the
septic system layout on file-no exceptions.
Declaration: Any permit or approval granted which is based upon or is granted in reliance upon any material representation 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 and agree to
abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
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PRINTNAME: BATE: �
SIGNATURE: - DATE
Town of Queensbury Building&Codes Principal Structure Application Revised September 2014
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' ' �, t- . P+am Casey - ( ML Contracting )
. I . �, ,tz D I'� !�I°* € 127 Grant Avenue Extension i
Septic tem - Leachtielcl only
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