2005-465 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050465 Application Number: A20050465
Tax 1\1ap No: 523400-301-007-0002-027-000-0000
Permission is hereby granted to: JASON WATERSTON
For property located at: 246 AVIATION Rd
in the Town of Queensbury,to construct or place
at the above location ul 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. Tyne of Construction Value
Owner Address: JASON WATERSTON
246 AVIATION Rd Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2005-465
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday, June 28, 2006
(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 exp ation date.)
Dated a the T of Que t sbu - uesday, June 28, 2005
V
SIGNED BY V for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation: w a � z l CX d
File Permit No. (dL
Tax Map No.
i Fee Paid _ cam=
Owner's Name: �t ,S o` '
.................................................................................................................................
Address: (
2. INSTALLERS NAME PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply #of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
T98irr � 43 x 150 gal/bdrm =
�— 1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes /
Spa or Hot Tub Installed yes^ / R
JUN M05
4. PARCEL INFORMATION: (circle applicable information&indicate measurements
OWN OF Obti=NSBURY
TgpogaRhv Soil Nature Ground Water Bedrock or impervious Materia (3U U�I�G ' 1
, san at what depth at what depth unzci
lng
loam feet feet we l
Steep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed
professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub.
Septic Tank;/{-,'�'�,' , gallon (min. size 1,000gal.)
� eld: each trench_ ' ft. Total System Length: ft.
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
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 application and agree to abide by these and all
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
a re of responsible person Date
-Tow't1 of Queell;bury
Smvem :tied Sews,
Ptr I)iq>a:.:LI tlttstjsier
Ahpontlix C.
All.,40It)".110N IP IIl-IA)
SEPARATION MiXIIARKNUNT48
1 �I
c
• Y{A5 Am wt-r.• � Ate... ��! ��•...�A. w •/�
O
PpNu
Al
••—
Sc t'i 1cly�,
It%I .1
• �x'Ir+ryRt'tr�1 s
' r
7, SICGN,ATURE &I oMkTION FMt MSklV ubusLrw rz^ovL, \y.o.►..,•.,..W `
10 ) 2pe-1
IV-
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection r quest ceiv Ce I;;)-
Queensbury Building&.Code Enforcement Arrive: am/p epart: Q
742 Bay Rd.,Queensbury,NY 12804 Inspector's Init Is-
NAME: E IT NO.: C�;Z
LOCATION: 0 PECT ON. a
RECHECK:
Comments and/or diaSram
Soil T . Sand/ Clay
Type of unici /Well Water
Waterline se arahon i ft.
Well separation distance ft.
Other wells: ft.
Abso tion Field: Total length ft.
Length of each trench
Depth of trenches ft.
Size of Stone G)
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank H 1%
Tank to Distribution Box 1
Distribution Box t eld/Pit '
Opening Seale . artial
ci-En—FCaps
Location/Separations � t
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft. loc>c)
Conforms as per Plot Plan VY N
Engineer Report and As-Built Y N
Location of System on Property:
Front Rear Left Side Right Side
Middle Fron 1 dle Rear
S stem Use St s:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 1/6/05
R
JUN
TOWN O� U��=NSBURY
BUILDING AND CODE
I
i
� IY
G
t
I $ 4
i
1
i
(? W
~
m c A4,
3
I �
E
� � I
I
I