2002-129 TOWN OF OUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
CER"1IFIr "IrE -OF COMPLIANCE
Permit Number: P20020129 Date Issued: Friday,March 08,2002
This is to certify that work requested to be done as shown by Permit Number P20020129
has been completed.
Tax Map Number: �23400-301.007.0002-020.000.0000
Location: 280 AVIATION Rd
Owner: RICHARD BRAUNS
Applicant: PAMELA/RICKW BLACKMER/BRAUNS
This structure may be occupied as a:
..By.Order.of Town Board
Septic Alteration Residential TOWN of QUEENSBURY
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
ti t
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Nitmber: P20020129 Application Number: A20020129
Tax Map No: 523400-301-007m0002-020-000m0000
Permission is hereby granted to: PAMELA/RICHARD BLACKMER/BRAUNS
For property located at: 280 AVIATION Rd
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: RICHARD BRAUNS Septic Alteration Residential
PAMELA BLACKMER Total Value
9 OLD FORT Rd
FT. EDWARD,NY 12828
Contractor or Builder's Name f Address Electrical Inspection Agency
OUEENSBURY SEWER
JAY SWEET
Plans&Specifications
2002-129
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES. Saturday,March 08,2003
(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 ;f Que �bury riday,March 08,2002
SIGNED BY for the Town of Queensbury.
Director of Buil i g& e Enforcement
Application for Permit-Septic Disposal System_
Town of Queensbury 7'42 Bay Road Queensbury,NJ' 12804 (518) 761-8256
I. OWNER INFORMATION:
......................................................................................._........._.....
t
� Once use
Location of installation:
Tax Map No.
File-Permit No cX`7
' / / -a
¢ C. 7 l ee Paid c�
Owner's Name-
Address: p. .�; l
:.................................................................................fi 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 tkt��.mIVED
Year of House: No. of Bedrooms x coilliRutation. = Total Dallv
Flow
0 2002
or�. ' x 150 gal/bdrin
1980- 1991 x 130 gal/bdrm = --fQvvjV0F QIlEENSBURY
1991 -present x 110 gal/bdrm = 1�1G AND CODE
Garbage Grinder Installed yes
Spa or Whirlpool Installed yes_ ! •
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)'
Topogyral2hy Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Suppl
I s at what depth at what depth tnrenicrp
21 calling 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 hce.nsed prvfessioi!a_ 1 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 gaIIons to the size
of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub.
Septic Tank:/"&L gallon (min. size 1,000 gal.) /
Tile Field: each trench fl. Total System Length:
Seepage Pit(s): number of___- size ofeach_ _ fi. by
Size of Stone to be used: It / depth or thickness
Bed System Size: - 7 f x U--Z>
. � r
Alternative System: 1'1 length and for 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,oftile Code of the Town
of Queensbury, any permit or approval granted which is based upou 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.
Imo''
Si , tur of r on ible person Date
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"! have seen or observed,or believe I saw evidence of,
all objects such as houses,wells,trees,fences,etc.,
shown on this document,I also represent.that I have
personally measured the distances set forth on the diagram."
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