2003-498 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20030498 Application Number:. A20030498
Tax Map No: 523400-296-061-0001-001=000-0000
Permission is hereby granted to: JOHN OGDEN
For property located at: 14 QUEENS Way
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 Cbristruction Value
Owner Address: SALLYANN M POOR Septic Alteration Residential
14 QUEENS Way '. Fatal value
QUEENSBURY,NY 12804-
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2003-498
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID'-THIS PERMIT EXPIRES: Friday,July 02,2004
(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 own Que sbyy; sday,July 02,2003
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Pern3it—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION-
...........F
Location of installation: e(ZAJ, Office Use
Tax Ma Na. File Permit No.U)
p
eNo
Owner's Name: N e,,,j Fee Paid
....................................
2. INSTALLER,S NAMF,
Ice ri-1011M NO.
3. RESIDENCE rTFOR1%1ATjON: (circle year of dwelling,indicate#bedroom(s) and multiply#of
bedrooms with applicable gallons per bedroom to equal total daily-flow)
Year of aggse: -No. Of Bedrooms x — Computation = Total Daily Flow
1980 or older x 150 gal/bdnn = �C)6
1980- 1991 x 130 gal/bdrm = �,=n IVED
1991 —present x 110 gal/bdrin = it
Garbage Grinder Installed yes no
Spa or Hot Tub Installed yes_ no JUL Z003
4. PARCEL INFORMATION: TOWN OF OL)EENS13URY
(circle applicable information&indicate measuremeigS)Lr)ING ApID CODE
To n 0 U�-Zgwp So" Nature Ground Water Bedrock Qr Impervious Material Dome&tir.Water Sui3ply
ldfqk/ AA—d at what depth at what depth
R`o71Fn-g loam feet ��7wci�a
—feet well
Steep slope clay if well;water supply
slope other from any septic-system
depth: I I I absorption is ft.
other
Percolation Test- (71>be completed by licensed professional engineer or architect)
Rate. minute per inch
S. PROPOSED SYSTEM; For New Construction: All individual sewage disposal systems must be designed by a licensed
professional engineer Or architect(unless installed in a Plaming 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: 1000 gallon (min. size.1,000gaZ)
Tile Field: each trench /ft. Total System Length:
Seepagepit(s): number of--1-- size 0feach:
Size 9f Stone to be used: # 3 J depth or-thickness feet
Bed System Size: x
Alternative System-, length and/or size
6. HOT DING TANK SYSTEM: (if required)
Number of tanks: I 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 RESPONS]BLE,PERSON(please read)
For your protection,please note that pursuant to Section 13629 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 malm a material fact or
ciradmstance known by or on behalf of an applicant,shall be void.
I have read the regulations with rewect to this application and agree to abide by these and all
rcquirern e Town of Que�n��ury Sanitary
7, nj y Sewage Disposal Ordinance.
Rdooll", /Z
U of respo
S gn Lure of respogsible person ate
YVA ef :eT '4n.T, P067/T0/L0
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received: -7 :7 63
rrj_/ 11
'Queensbury Building&Code Enforcement Arrive: am/ epart: ani/pra
742 Bay Rd., Queensbuly,NY 12804 Inspector's lnitialsl��
NAME: PERMIT NO.:
LOCATION: INSPECT ON:
RECBECK:
Comments and/or diagram
Soil T e. Sa -lay
Type of Water:(MuniciLp j/Well Water
Waterline separdhiau_kKtance
Well separation distance
Other wells: ft,
Absorption Field: Total length
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: _5 x
Stone Size: -0-7
Piping Size Type
Building to tank
Tank to Pie�� /517
Distribution Box to Field Pit
Opening Sealed: Y/NI Partial
Location/Separations
Foundation to tank
Foundation to abso2tion ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Location of System on Pro erty:
Front Rear eft Sid Right Side
Middle Front Middle Rear
system Use Starus.•
:V:::—Approved
Partial Approved and needs to be re-inspected,please call the*Building&Codes Office
Disapproved
LASueHerningway\I3ui1ding.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
Q-950 3-
20
TOWN Of QUEENSBUF Y BUILDING DEPARTMENT
Based on odr 1 mited examination,
compliance with our comments shall
not be construed as indicating the
/ plans and s cations are in full
compliance with the Building Codes
of New York Sta e.
BUILDING '%0
REVIEWED BY
DATE
:)A;/e seen or observed, or {;�r eve 1 saw evidence of,
iu."h as Douses, `-ees, fences, etc.,
".Im" ;r, . �;Gi,t that I have
p, rson,ily
r rth on the di am."
i
SIGNAI .. SAT"