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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, . ....... .... .