2001-304 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010304 Application Number: A20010304
Tax Map No: 523400-131-000-0004-003-000-0000
Permission is hereby granted to: BENJAMIN& EVA ELLIS
For property located at: 31 THOMAS St
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: BENJAMIN& EVA ELLIS
31 THOMAS St Septic Alteration Residential
QUEENSBURY, NY 12804 Total Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
IBS SEPTIC& DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY,NY 12804
Plans & Specifications
BP
SEPTIC ALTERATION AS PER PLOT PLAN AND SPECIFICATIONS
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,May 16,2003
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town o ueensbu ; AWednesday,May 16,2001
/J SIGNED BY for the Town of Queensbury.
Director of Building& e orcement
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
• 1. OWNER INFORMATION:
Location of installation:/ 3 /14 ® /�, ' (A, Cif • Oflicc Use r�,�
Tax Map No. 3` / 7 / • File Permit No 661-`
Owner's Name: . )- Fee Paid
•
/j.c.' ,� , ter, , ,� �C, S
Address: 3 / l`.'- - a-vC .
2. • INSTALLER'S NAME : , t lir 57 St^ / , •
. . PH NE NO. _
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate #bedroom' i�
(s)and multtplT r •
bedrooms with applicable gallons per bedroom to l allogrlz lei flow)
Year of House: No, of Bedrooms x• _ Computation = T� '"`otraC'I aHI}�a131i t1RY
1980 or older 0
cisc x 150 gaVbdnn =
1980— 1991 - x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes_ I,`no
Spa or Whirlpool Installed yes / no
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
. . ___ : S9 OLQUnd_Vtialgr D4aroC_k.vr�tnporYiPa! gtQri�l. `�tor_$upply
at what depth at ► ra4pjh municipal•
ng oam /
_/1 et. • eet
Steep slope clay ' fle if well; water supply
_• /o slope other froth any septic-system
depth: absorption is fl,
other
Percolation Test: (To be.completed by licensed professional engineer or architect) •
Rate: mimic 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: ®Qa gallon (min. size 1,000 gal.) pl.,-5/
. Tile Field: each trenchCOft. . Total System Length: -� " t. TA, ' C '��`r
C
Seepage Pit(s): number of size of each: f. by
f1.
Size of Stone to be used: II - / depth or thickness_____.______fret
Bed System Size: x
Alternative System: 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 Quoonsbu"ry, 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 those and all
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.,
' .V. __La_L---C,- ZZ(..., 5.14,:cdDc')/ : . -
ure of respons I.person ' Date
•
TOWN OF QUEENSBURY l , ,30
BUILDING_6 CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518)761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
(2__
Name ":1/, ,S Y PY SC( \i /1
Location -3/ Ihrstua S Sic .
Date 5 i )/ Permit # ) -3O4
SOIL TYPE: 100.am-Clay-
Results off \-rcdlat on Test-
(if applicab e) Rate Minute/Inch
TYPE OF SYS
ABSORPTION FI•LD: I .tal Length 7m
Length of each tre - h SQL-lot
Depth of trenc -s I-�"
Size of stone .TI
SEEPAGE PITS: Y er-
Size - x ft.
Stone size -
PIPING: Size ype
Bldg. to Tank Al"Ft TA, 1-1" 'a_S
Tank to Dist. Box L44
Dist. Box to Field •I (Jib
Openings Sealed So Partial
LOCATION/SEPARAT 1 . :
Foundation to Tank t p feet
Foundation to Absorp' ion in feet
Separation of Pits •i _ feet
Conforms as per Plot plan i'(gioNo
LOCATION OF SYSTEM OM PROPERT :
(circle one
Front - Rear . Left Si_'d� Right Side
Middle F .n - .. • - .
COMMENTS:
SYSTEM USE APPROVED: 'YES NO
Arrived:
Depa
�� it rng nsp t r
(0 ( o m w -4
a < C cc
'� I/ 1 m m Q
*---r r
•Z � �o Z
0Eo d
s—
c
- s 1 � p
s
< — I C
c rl C 1 r1
r S
a � 9
Xmas,
'„T, 4 1
L- C 5 G1
C F "I have seen or observed, or believe I saw evidence ol;
all objects such as houses, wells, trees, fences, etc.. Q
shown on this document. I also represent that I have
personally measured the distances set forth on the diagram i
SIGNATURE (,6 DATE