2009-428 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090428 Application Number. A20090428
Tax Map No: 523400-301-020-0001-020-000-0000
Permission is hereby granted to: MICHAEL& SHELLEY GALE
For property located at: 44 LEO St
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 Value
Owner Address: MICHAEL& SHELLEY GALE
44 LEO St Septic Alteration Residential
QUEENSBURY, NY 12804 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2009-428
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, September 09,2010
(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 To eensbPfy, yVd sday, September 09, 2009
SIGNED BY r:, it - -. for the Town of e Qu ensbury.
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbtuy,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090428 Application Number. A20090428
Tax Map No: 523400-301-020-0001-020-000-0000
Permission is hereby granted to: MICHAEL& SHELLEY GALE
For property located at: 44 LEO St
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 Value
Owner Address: MICHAEL& SHELLEY GALE
44 LEO St Septic Alteration Residential
QUEENSBURY,NY 12804 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2009-428
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, September 09, 2010
(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 th o f Qu bji esday, September 09,2009
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
-^^^~^~^—~--~~—~~~~^~~~—~-^~~~~^~~^^-^~~~~'
OFFICE USE ONLY
--_- ' /*X MAP NO. PERMIT~ PERMIT FEE
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEAV ik�i
APERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
pERMIT `
OWNER: e leINSTALLER: ec-*S' "ZL?e r-S
ADDRESS:— ADDRESS:
PHONE NOS. PHONE NOS. 72
r
LOCATION OpINSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT BEDR.OOMS x COMPUTATION= TOTAL DAILY FLOW GARBAGE G N
INSTALLED?_IC____
SPA OR
1992-present 110 gallon per bedroom INSTALLED?_�_���__
PARCEL INFORMATION: .
~~ : Steep slope 96S\npe_____
� Sand-- Loam Clay_ [ther______
� : At what depth?
~' BEDROCKAMPERVIOUS MATERIAL: A1 what depth?
______.
DOMESTIC WATER : Municipal VVmU 0fvveU: VVabarsupply�omoany septic
� system absorption io .\
v~ PERCOLATION TEST: Rate is � - `~ minutes per inch RNPO
(Test tobe completed bvalicensed professional engineer or architect.)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by
licensed (unless installed }no Planning Board approved mubdkviaion\.
TANK SIZE. /n�/, , GALLON (MIN. SIZE IS 1.000 GAL.)Add 250 gallons to the size of the ompUu tank for
each garbage grinder, spa or whirlpool tub.
TYPE:SYSTEM
�
X ABSORPTION FIELD (WITH NO. 2STONE) Total length Each trench x______
�l
.� SEEPAGE P(T(8) (WITH NO. 3STONE) How many? Size?
ALTERNATIVE SYSTEM Bed urother type?
El HOLDING TANK SYSTEM Total required capacity?.
Tank size? Number of tanks?
__________
-'- --'--'- -'--'----' --- - --- -----'------.----`-.-.-...,..^,`,,. ..
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
| APPROVED ELECTRICAL INSPECTION ASENCY_. PLEASE REVIEW LIST PF�OV|OED )
L..-....-.-..........~--,~`-_-~~'~-_`_.^,~^,_..^_^_ ,,_,_, ,`,^,^,'_`_`.^.^.,~^.^^^..^^.._.._,_.,____, �..___^`~~,~,_~,~~^,^^^,_,'.,]
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.
Septic Inspection Report
Office No. (518) 761-8256 Date Ins ection r eiv
Queensbury Building &Code Enforcement Arrive: apart �:b� am m
742 Bay Rd., Queensbury, NY 12804 Inspector's Ini
NAME: Gn' ERMIT NO.: O9 —i-1Z43
LOCATION: 4 1-k INSPECT ON: 9 tD --n�?
RECHECK:
Comments and/or diagram
Soil TOng / Clay
T of Water: ' al/ Well Water
Waterline separation distance
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + J - Y N—NIA
Absorption Field: Total length ft.
Length of each trench
Depth of trenches `tr ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank L t'
Tank to Distribution Box 4''
12
Distribution Box to Field/ Pit L4`` c) -
0 nin Sealed: Y N
End Ca Y
Inle Outlet Pipes&Baffles N
Location Separations
Foundation to tank
Foundation to absorption
Separation of Pits ft.
Conforms as r Plot Plan Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front R r eft Sid Right Side Middle Front Middle Rear
Svstem Use S
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 U\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
observed,or bel' I sew evidenced,
wcIls, trees, fuses, CtL.,
I also represent that I have
cl�.St�iicf-ls SCA rth Oil the di,
. ....... .... .