97-118 BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 97118
TAX MAP NO. 148. —3-63 WARREN COUNTY, NEW YORK
tb-'6t 27
PERMISSION is hereby granted to MICHAELS GROUP
OWNER of property located at LOT 6 3#115 HUDSON POINTE BLVD. Street, Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC ALTERATION
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
1810 ROUTE 9
LAKE GEORGE, NY 12845
2. CONTRACTOR or BUILDER'S Name
MICHAELS GROUP
3. CONTRACTOR or BUILDER'S Address
1810 RTE 9
LAKE GEORGE , NY 12845
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( ) Masonry ( I Steel ( )
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
April 9 19 99
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 9 April 97
Day of
19
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury F.
7,--
Dept. of Community Development Permit No.
Building &Codes Office c r
742 Bay Road Fee Paid:J) �A/
Queensbury, NY 12804 1 r
Location of property for installation: (I. gAt. SclY1 �t r 3
Property Owner's Name: T 't (�-t t c.ka-e ���� ` y f
1 APR 08 1997
Property Owner's Mailing Address: 1 1 S r k.0 c uv1 ?(- p(v i)
Installer's Name: Re,(— 61 et 10 44.G • Phone # r ' -7)12 14 6'i L E
p 7/L
Number of bedrooms (if residential): Lf Total daily flow: 6 Z fc) i R-4) G J0 V-126
(residential - compute @ 150 gal./bdrm.)
Topography: ✓flat, rolling, steep slope % of slope
Soil Nature: '-and, loam, clay, other /depth:
Ground water: at what depth? feet / Bedrock or Impervious_Material: at what depth? _ feet
Percolation test: not required, required [rate(J)1`/ 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
Septic tank:(ZSv gallon (minimum size: 1,000 gal.)
Tile field: each trench S feet / Total system length: feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: It / depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
I
Alarm 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 applicati and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal Date: 01)Signature of responsible person: 7
hE 5ED -E\
TOWN OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804 •
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION ,
Name tcl,AR 4 GRa)P
Location N )� ( w Pa _D„
Date L}-7--9'7 Permit #
SOIL TYPE an. Loam-Clay-
Results of Percolat'on Test-
(if applicable) Ra -Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD. To al Lergth ,1
Length .of each renc �. . - ,�
Depth of trenches
Size of stone
SEEPAGE PITS: Numb r-
Size - �t-
Stone size
PIPING: Size Type
Bldg. to Tank6
Tank to Dist. Box
Dist. Box to Field/Pit ��
Openings Sealed? Yes ���No Partial
LOCATION/SEPARATIONS:
Foundation to Tank :'l.,101 G feet
Foundation to Absorption L -feet
Separation of Pits _ feet
Conforms as per Plot Plan Ye, o
LOCATII OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Lef Right Side
Middle Front - •
� R
COMMENTS:
ED 6EPgIC A o.
F 1 1--,QED t U FEE
PR
— 13E P E-\) QED li-NERCA
SYSTEM USE APPROVED: YES (- p
Arrive . )�
Dep ted- f:,
Buildin I Spector
0
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