97-280 BUILDING PERMIT
VALUE 0 TOWN OF QUEENSBURY No. 97780
TAX MAP NO. 58. -1-9 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to DOUGAN, THOMAS & TONN.A
OWNER of property located at 390 RIDGE RD. 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. OWNERS Address is
447 RIDGE RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
SANITARY SEWER
3. CONTRACTOR or BUILDERS Address
DAN DRELLOS PO BOX 224
GLENS FALLS NY 12801
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( 1 Wood Frame ( 1 Masonry ( )Steel ( 1
7. PLANS and Specifications
No.
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID -THIS PERMIT EXPIRES June 3 19 99
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date.)
Dated at the Town of Queensbury this 3 Day of June 19 97
SIGNED BY 741 for the Town of Queensbury
Buildi and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Qn sbury Permit No.q---)- )8L
Dept. of Community Development
Building&Codes Office iJ(^9 G�
742 Bay Road Fee Paid
Queensbury, NY 12804
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Location of property for installation: I ( 7 Z Rp
Property Owner's Name: 1---S /4--( 1J 9 CI /}A)
Property Own 's Mailing Address: Q.- 9- '7 #'e fi l ZP
Installer's Name: i f N 0-7/"7 4-6," �. Z Phone # 7 9 2- -7Z s3
Number of bedrooms (if residential): Total daily flow: gil-)
(residential - compute @ 150 gal./bdrm.)
Topography: c2 mom, steep slope % of slope
Soil Nature: sand, loam, clay, other /depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: not required, required [rate min. per inch]
Domestic water supply: X municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is
RECEIVED
PROPOSED SYSTEMfl x 10Tfti
Septic tank I o gallon (minimum size: 1,000 gal.) JUN
2 ,
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TOW v, �a ,a r: AIRY
Tile field: each trench ✓ 0 feet / Total system length: 2 3 ., ILD NO A',°'�CODE
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: # fi /
/ depth or thickness ( feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
(Alarm system and associated electrical work to be inspected by a certified agency.J
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 to , .•. • .•. and abide by these and all requirements of the Town of
Queensbvry Sanitary Sewage • .
1-0) 9 ?7
Signature of responsible person: At Date:
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Amennem
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT "`3a\k\N
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name C.
Location L-1 .7
Date 6<-317Permit # - a
SOIL TYPE: n lay-
Results of Percola Test-
(if applicable R. - inute/Inch
TYPE OF SYSTEM: i
ABSORPTION FIELD otal Length 7 J1
Length of each t ench
Depth of trenches t ' - Z' (:*)
Size of stone IV 7 REto
SEEPAGE PITS: Nu er-
Size - ft. x .
Stone size
PIPING: Size Type
Bldg. to Tank E V4 -
Tank to Dist. Box 1411
Dist. Box to Field/Pit "%
Openings Sealed? No Partia
LOCATION/SEPARATIONS:
Foundation to Tank V:4_07 feet
Foundation to Absorption 5-0-ti.-feet
Separation of Pits feet
Conforms as per Plot Plan 4p2No
LOCATION OF SYSTEM ON PROPER
(circle one)
Front - Rear - L- ide - Right Side
Middle Front Middle Rea.
COMMENTS:
SYSTEM USE APPROVED: 01° NO
Arrived: 12 a •
Depart:. ;1,
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