2002-858 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building 4c Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010858 Application Number: A20020858
Tax Map No: -523400-301-017-0001-033-000-0000
Permission is hereby granted to:
For property located at:. 3 CHEROKEE Ln
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. Ty
pe of Construction Value
Owner Address: ALAN&JESSICA HEWITT Septic Alteration Residential
3 CHEROKEE Ln Total "Value
QUEENSBURY,NY 12804
Contractor or Builder's Name Address Electrical Inspection Agency
Plans&Specifications
BP 2002-858
Septic Alteration as per plot plan and specifications
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,October 11,2003
(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 Tow of Qu sb er 11;2002
SIGNED BY /I 4� for the Tomin of Queensbury.
Director of Building&Code Enforcement
Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY. 12804 (518) 761-8256
1. OWNER INFORMATION:
............ .................. ........................
Office Use
Location of installation: 30 File Permit No.
Tax Map No. _1_1 - 17-, -_3 3
;A
Owner's Name: Fee Paid
.......................................
....
Address: ........................................
2. INSTALLER'S NAME PHONE N6.Y
3. RESIDENCE INFORMATION-.' (circle year of dwelling,indicate 4 bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total dailyflow)
Year of House: No. of Be&-qMs x Computation = Total
Daily Flow tL;
150 gal/bdrra =
1980-1991 x 130 gal/bdrm = OC T -1 1_20
0i
1991 -present x 110 gal/bdrm = 0VVjV OF-0-
Garbage Grinder Installed yes M& (-,06E
Spa or Whirlpool Installe.d yes
4:- PARCEL INFORMATION: (circle applicable inform ation&indicate measurements)
Tonqgraphy Soil Nature Ground Water 'Bedrock or Impervious Material Domestic Water SURMY
�Fl at What depth at what depth
Rolling loam -feet
-feet well
Steep slope 014 (fWell;water supply
%slope other
from any septic-system
depth: absorption Is
other
Percolation Test; 0 be completed by licensed professional engineer or architect)
Rate: minute per inch,
5. PROPOSED SYSTEM: For New C9nL1,iW!;4Rg: All individual-siewage disposal systems must be designed by a licensed
professional engineer or architect(unless-installed in a PI
aniliojtoaid,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:,,- etZ47 gallon(Min. size 1,000 gal.)
Tile Field:,each trench Total System Length:
Seepage Pit(s): • number of size ofeach: - by-ft.
Size of Stone to be used: # depth or thickneis feet
Bad System Size: x
Alternative System: 4 lzng 4<S: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number.of tanks: l Size of each: gallons /TOTAL Capacity: gallons-
Note. Alarm System and associated electrical work must be inspected by a Town approved.
electrical inspe6tion 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 rrxisrepresent4doft or failure to -make a material fact or
circumstance known by or on behalf ofan 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 Queensbuxy Sanitary Sewage Disposal Ordinance,
S 9 re Ic
ig at rb(of responsible person, Date
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BUILDING DE , -PT.
REVIEWED BY
DATE