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BOTH-000134-2016 G a o N �- o O o r U W C,q " � w 48 sem, CY c O OF 00 W) `O ai W) ^d � M c� onv 2 a O a o V q O 0 C� Q M opo cn to O Q rT © N cn U O CJ a 4-4 N ¢' Q - Sal 14 yC �aw TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: BOTH-000134-2016 Tax Map No: 295.18-1-25 Permission is hereby granted to: RICHARD ROBERTSON,Cooks Septic For property located at: 34 PINION PINE LN 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 filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance Type of Construction Owner Name: RICHARD ROBERTSON Septic Disposal $0.00 Owner Address: 34 Pinion Pine LN Total Value $0.00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Cooks Septic 194 Hall Hill Lake Luzerne,NY 12846 Plans&Specifications Residential Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,March 11,2017 (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.) Dated at the Town o nsbury; W s ,March 16,2016 4 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement SEPTIC DISPOSAL APPLICATION Office Use Only Received DATE: Tax Map ID TAx MAP ID: ,,� /- 0 d e (7,��, —66V.- Permit No. P� - I?Zg 2�7I Permit Fee v ZONE: APPLICANT l L O I��,, ; Il J PHONE/E-MAIL - !I r ADDRESS t`oil INSTALLER/ PHONE/E-MAIL BUILDERi G l x _ OWNER r C o ff/ ADDRESS ! d41% �H*C - U MAR 15 2816 CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: PHONE 0 E-MAIL WN 0 V RI'PIP RESIDENCE INFORMATION Year Built #of bedrooms X gallons per bedroom =total Daily flow 1980 or older Garbage grinder installed Yes ANo 1981-1991 Spa or Hot Tub installed Yes o 1992-Present PARCEL INFORMATION Topography Flat rolling Steep slope %Slope Soil Natureand Loam Clay Other Groundwater At what depth: Bedrock/Impervious material At what depth: Domestic Water Supply Municipal Well(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 WOgallons(min.size 1,000 gallons,add 250 gallons to size for each garbage cylinder or spa or hot tub System Absorption field with#2 stone Total length Z oU ft.;Each Trench 1 Seepage Pit with#3 stone How many: _;Size Alternative System Bed or other type: Holding Tank System Total required capacity? Tank size #i of tanks f 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 r uirements/of the Town of Queensbury Sanitary Sewage Disposal Ordi ante. /^ PRINT NAME: (/"G` C / t DATE: C4 I J l SIGNATURE: DATE: Town of Queensbury Building&Codes Principal Structure Appikation Revised September 2014 SEPTI �'LO'�f L.A�' FILE COPY I HAVE SEEN OR OBSCRVCD ALL OBJECTS SUCH AS HOUSES,WELLS,'TREES, FENCES. ETC SHMAIN 0 ` S DOCUMENT.l HAVE PERSONALLY MEASU TFIE D 'TANCE S Ofj3kf IAGRAi . 7 DATE f. ct 1701, (101 t r f l t fit C' SPY E t TOWN OF QU B MAR 15 2016 BUILDING & OD - r Reviewed By: t IWNMF�'—OU E0€ 4_ � � Date: �.,.a, D-1 l zqj Zo 3{ �� lfit k � �; s MAR 2 1 2016 ING a CODES yJr�'�I to P5 L'o L T U � 1 "I