99-755 btiit i dopiince
Town of Queensbury
Warren County,New York
December 14 99
Date, 1
99755
This is to certify that work requested to be done as shown by Permit No.
has been completed.
SEPTIC ALTERATION •
This structure mDi AVEbfiyie�d EST .
Location
MULCAHY, DAVID &
Owner
TAX MAP NO. 97 . -1-1 . 3
By Order Town Board
TO QUE S
"ice
Director of Building&Code Enforcement
Air ,.. �z �_ _--- --
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 0 Building Permit No. 99755
TAX MAP NO. 97 . -1-1 . 3
Permission is hereby granted to MULCAHY, DAVID &
Owner of property located at 27 HILLCREST 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 NYS Uniform Building Codes and the Queensbury Zoning Ordinance.
Owner's Address:
JACQUELINE 27 HILLCREST AVENUE
QUEENSBURY, NY 12804
Contractor or Builder's Name:
COOKS SEPTIC
Contractor or Builder's Address:
12801
Electrical Inspection Agency:
Type of Construction:
SEPTIC
Plans and Specifications:
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
Proposed Use:
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID—THIS PERMIT EXPIRES December 9 2001
(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 Town of Queensbury this 9 Day of December 1999
SIGNED B >E?for the Town of Queensbury
C Enforcement Officer
—r Application for Permit—Septic Disposal System , '
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 L ; ' ,,
1. OWNER INFORMATION: 1y99
.74
7 f�,st Office Use
Location of instal ation: l /
7 File Permit No. - Se
Tax Map No. / / /
Owner's Name: e" Ut j /77"/ ( Q 4 Fee Paid � c g�/�
Address: ' :� TIV J s ,
. - 02. INSTALLER'S NAME : - ) 11 fiv✓ PHONE NO. (i
3. RESIDENCE INFORMATION: (circle year of dwel mg, 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
1980 or older 3 x 150 gal/bdrm =
1980— 1991 0 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =-
„--7.--
Garbage Grinder Installed yes / no
Spa or Whirlpool Installed yes / no
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
rra h Soil at re Ground Water Bedrock or Im ervious Material ter Supply
Flat- ! sand —' at what depth at what depth �munici
Rolling loam feet feet well
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 trench 6 ft. Total System Length:^ 1V fi.
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:./, / c k, 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 respe this ap lication and agree to abide by these and all
requirements of the T. 1 of ueen u Sew a Disposal Ordinance.q Q ar P
-0, , / - , 4/edir tii" .4/, .- ,
Si u a ure of r •o sible person at
44/:
TOWN of ` `+
FINAL INSPECTION CERTIFICATE PROPERTY TAX MAP NO.
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The above sketch shows the locations..of the units comprising your sewage disposal
system for future reference in case of difficulty. It shows measured distances
from buildings, trees, garage, fenceeposts, etc. , to the components of your sewage
disposal system. ,-,
/off / /i / f�
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CONSTRUCTED BY: / 7/ ` ." DATE INSTALLED:
DESIGN BASIS
1. No. of bedrooms: ``�?
5. Septic tank: type
2. Daily flow: _ ... gpd capacity _.__.... , gals. ' .
3. Undisturbed soil depths: device:
s
p 6. Size of leach jng /14 .1 ft.
' ' a. . To groundwater:
7. Type of systeur(conventiona1., M l ,
b. To impervious len___ etc.): .�. .
4. Percolation rate: min/in.
APPROVED BY: DATE:
.
Town of Lake Lu erne
BuiIdintt and Zoning ' partment
`Labe Luzern To n Hall
v '51 Main Stree
APPLICATION FOR A PERMIT TO CONSTRUCT, ALTER OR ENLARGE A
SEWAGE DISPOSAL SYSTEM WITHIN THE TOWN OF LAKE LUZERNE
OCCUPANT'S NAME ADDRESS
TELEPHONE: OWNER'S NAME
ADDRESS
NUMBER OF BEDROOMS GARBAGE GRINDER?_(YES)(NO)
TOPAGRAPHY: FLAT,ROLLING, STEEP SLOPE, GENTLE SLOPE,
OTt IER
NATURE OF SOIL: CLAY, SANDY, LOAM, GRAVEL, ROCK, ETC.
PERCOLATION TEST , WATER SUPPLY: MUNICIPAL, WELL, OTHER
DIAGRAM OF PROPOSED SEPTIC SYSTEM
OTHER PERTINENT INFORMATION:
IT IS HEREBY AGREED THAT IF THIS APPLICATION AND PLANS ARE APPROVED,
INSTALLATION OF SEWAGE DISPOSAL FACILITIES WILL BE MADE IN
ACCORDANCE WITH DETAILS SHOWN.
DATE SIGNATURE OF APPLICANT
DATE
1„,eAvild t-lulce- IN
0-1 t-,-pLk.c.A.-eur 4.4 .-75-3
Que
n,
", . .een or observed, or believe I saw evidence of,
ail rjs such as houses, wells, trees, tence.s, etc.,
I i sh . ir ,....ri thIs document 1 ' rc. es . ith ave
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pe,elly rtysiireQe av„' et fo " n the dia ram
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99755 97 . -1-1 . 3
MULCAHY, DAVID &
27 HILLCREST AVE.
MTV' LIAMITTIOL
(7)
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
1 �..,
Name _� Jt ^.� 1
(OiA
Location
Date la- 1 Lt-C4Permit
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rat-- 'nute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: otal Length
Length of each tr: nch Ic
Depth of trenches t
Size of s ' e N, i
SEEPAGE PITS: ' ber-
Size - f . x ft.
Stone size -�
PIPING: Size Type
Bldg. to Tank Y''
Tank to Dist. ;ox y" ,rx''=
Dist. Box to F'el d/Pj t y' fnlf;
Openings Seal 'd? ( Yes No Partial
LOCATION/SEP, ' ,TIOI /
Foundation t,. Tank krill, feet
Foundation to Absorption 24.. feet
Separation o+ Pits feet
Conforms as per Plot Plan (i No
LOCATION OF SYSTEM ON PROPERTY:
(circle o
Front - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: 6_6) NO
Arrived: /Ad;
Departed:
9f
Building Inspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT jot
742 Bay Road
Queensbury NY _12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name C6 -
LocdtIon ( Ll a
Date /.)- 3 9`7� Permit #
SOIL TYPE: and-Loam-Clay-
Results of Percolation Test-
(if applicable) Rat- '1 .te/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: 'otal Len.th
Length of each tre ch
Depth of trenches
Size of
SEEPAGE PITS: N ber-
Size - f . x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Bix
Dist. Box to Fi •ld/Pit
Openings Sealed. Yes No Partial
LOCATION/SEPA' IONS:
Foundation to ank feet
Foundation to absorption feet
Separation of Pits - feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
S ivd/r
SYSTEM USE APPROVED: YES NO
Arrived: //1
Departed:
Building Inspector
33
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name //AI/
Location 1 jAce/
Date /21 1- Permit # 4 -75r
SOIL TYPE: and, oam- Cl ay-
Results of Percolation Test-
(if applicable) e-Minute/Inch
TYPE OF SYST a .
ABSORPTION FI: D: Total Length _
Length of each trenc
Depth of trenc es
Size of stone
SEEPAGE PITS: er-
Size - x ft.
Stone size
PIPING: Size Type
Bldg. to Tan.
Tank to Di . . Box
Dist. Bel to Fi el • Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIt :
Foundation to Tank feet
Foundation to Absorp ion _ feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle o
Front - 42,
Left Side - Right Side
Middle - Middle Rear yo
COMMENTS: _ vy
Lb.( <' .24i 94., 3 z
L4 .- J � z
add �y ye
SYSTEM USE APPROVED: YES ONO
Arrived: 3'/)
Departed:
T
Building Inspector