2003-906 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: V20030906 Application Number: A20030906
Tax Map No: 523400-309-006-0001-057-000-0000
Permission is hereby granted to: TDA COWLES LF
For property located at: 20 HARRIS St
in die Town of Queensbury,to constructor 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: IDA COWLES LE Septic Alteration Residential
MELVIN COWLES TRUSTEE Total Value
20 HARRIS St
QUEENSBURY,NY 12804
Contractor or Builder's Name Address Electrical Inspection Agency
OUEENSBT TRY SEWER
JAY SWEET
Plans&Specifications
2003-906
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, October 30, 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 T um of ueeni da October 30, 2003
SIGNED BY 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) 76.1-82.56
1. OWNER INFORMATION:
Office Use
Location of installation:
Tax Map No. File Permit N
Owner's Name L C .
Fee Paid
........................... ......................
Address: 6 SZ--
2. INSTALLER'S 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 ComRutation = Total Daily Flow
T19980 or 6 de x 150 gal/bdrm =
S0— 1991 x 130 gallbdrm =
1991. —present x 110 gal/bdrm =
Garbage Grinder Installed yes
Spa or Hot Tub Installed yes
RFCF1VED
4: PARCEL INFORMATION: (circle applicable information&indicate measurements) ()C-T 2 9. 2pct3
Too graphy Soil Nature Ground Water Bedrock or]Impervious Mate rW.
<�� u
at what depth at what depth T r
Rolling loam —feet -feet _jB S I we k-
Steep slope clay if well; water supply
%slope other from any septic-system
depth: absorption is
Percolation Test: (To be completed by licensed professional engineer or architect} other
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.
Sep-tic Tank: ,2�p er gallon (min. size 1,000 gal)
-44fc—,Field: each trench ft. Total System Z;Z za f
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 Systcm:, --f V-ci 4c r, 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.
XO
Slgi)qtuVe f responsible person- Date
Septic Inspection Report
Office No. (518)761-8256 Date Inspection re st re ei .d
Queensbury Building&Code Enforcement Arrive: m/pm rt: r /pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initi
NAME: IT NO.:
LOCATION: SPECT ON:
RECHECK:
Comments and/or diagram
Soil
Type of unici 1 Water'
Waterline on distance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench
Depth of trenches ft
Size of Stone
--Seepage Pits: Number
Size: X
Stone Size:
Piping Size Type
Building to tank -I
Tank to Distribution Box
Distribution Box ld/Pit
[Opening Sealed artial
Location/Separations
Foundation to tank
Foundation to absorption 72D ft.
Separation of Pits z ft.
Conforms as per Plot Plan Y N
Location of System on Property:
Front Rear Left Side Right Side
__Middle Froa.—P�Siddle Rear
System Ilse St us;
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
-Disapproved
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