2005-495 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050495 Application Number: A20050495
Tax Map No: 523400-295-019-0002-019-000-0000
Permission is hereby granted to: STAC;EY RENOLDS
For property located at: 6 OWEN Ave
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: JOHN& LUCILLE CREEDON
Septic Alteration Residential
6 OWEN Ave Total Value
QUEENSBURY, NY 12804
Contractor or Builder's Name / Address Electrical Inspection Agency
IBS SEPTIC
IVAN BELL
2 LOWER WARREN STREET
OI TEENSBI TRY_ NEW YORK
Plans&Specifications
2005-495
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,July 08, 2006
(If a longer period is required,an application for an extension must he made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury; F iday,July 08, 2005
SIGNED BY for the Town of Queensbury.
r Buil ing ode forcement
D-9S r�
Application for Permit-Septic Disposal System w
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION: ..................... ..:__._.................................................................................
..........,
Office Use
Location of installation: /�
File Permit No. L
Tax Map No. ! /
Fee Paid
Owner's Name: C ti 0
?....................... . ........................... r ............................
Address: iv V
2. INSTALLER'S NAME s `�.
t1 PHONE NO. JUL 0 6 �,005
3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s)and multipleUEENSBURy
bedrooms with applicable gallons per bedroom to equal total daily �1G X+ Q CODE
Year of House: No. of Bedrooms x Computation = Total Daily Flow
fill
1980 or older x 150 gal/bdrm = `x✓
1980— 1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes_ / no 11F
Spa or Hot Tub Installed yes_ 1 no
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
I
h a e Ground Water Bedrock or impervious Material r Su 1
Fla sand at at epth atowtf fiepth unicipal
ling eet feet
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 1,000 gal.)
Tile Field: each trenchQr f t. 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 1 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
i
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
j4
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nature of respo sible person Date
Septic Inspection Report
Office No. (518) 761-8256 Date InsTL/0
ion request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: kffiot (j
NAME: �'n c-- PERMIT NO.: f� J t _
LOCATION: ( � U L-tc4, INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand L /Clay
Type of Water u! c p /Well Water
Waterline sea ance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench 0 t- ft.
-Depth of trenches `.3 a
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Pilping Size Type
Building to tank Y& AYY6
Tank to Distribution Box 41"
Distribution Box Kield/Pit t
Opening Sealed: N/Partial
End cap*
Location/Separations
Foundation to tank 0 ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front Rear Left Side fight Sid
Middle Front Middle Rear
System Use Status:
Approved
_ Partial Approved and needs to be re-inspected,please call the Building& Codes Office
Disapproved
Last revised 1/6/05
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