2002-932 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20020932 Application Number: A20020932
Tax Map No: 523400-301-020-0001-045-000-0000
Permission is Hereby granted to: JAY SWEET
For property located at: 17 LANCESTIRE Dr
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 o£Construction Value
Owner Address: CRAIG&BARBARA MEADS
17 LANCESTIRE Dr Septic Alteration Residential
Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2002-932
ir•F
Residential septic alteration per plot plan and specifications. F"- s• "`'
F +Y
o
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,November 07 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 ens Thu sday,November 07,2002
SIGNED BY bu ,v ) /61 for the Town of Queensbury.
Director of Building& ode E rcement
Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION-.
..........
/,7 Office Use
Location of installation: of" of 4�
Tax Map No. File Permit No.
Fee Paid
Owner's Name: �Lct -q—,
..............--....................................... ...........................................
Address:
2. INSTALLER!S NAME C sz -C PHONE NO.Z7 Z3
3. RESIDENCE INFORMATION: (circle t
year of dwelling,indicate 9 bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No of BedZo=s x Computation = Xqjal Dail Flow
1980 or older x 150gaYbdrjrn =
1980-1991 x 130 gaYbdrm =
x 110galfbdrm =
Garbage Grinder Installed yes RECEIVED
Spa or Whirlpool Installed yes—
NOV 0 f22002
- 4.*- PARCEL INFORMATION: (circle applicable information&indicate measurements) TOWN OF QUEENSBURY
BUDDING AND_CODE
TgRogmpby Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
at what depth at what depth municipal
Rolling olam feet _feet we
Steep slope clay if well;water supply
Yo slope other from any septic-system
depth: absorption is
m_fit
other
Percolation Test: (7b be completed by licensed professional engineer or architect)
Rate: minute per inch
5. PROPOSED SYSTEM: For-New gonsj�M$49n: All individual sewage disposal systems must be designed by a licensed
professional engineer or architect(unless installed in a Planning Board approved subdivision). Add250 gallons to the size
of the septic tank and leach field,for eaph Garbage Grinder,Spa or Whirlpool Tub.
Septic Tank-/;04�ZP gallon(min, size.1,000 gW4)
Tile Field: each trench ft. Total System Length: ft
Seepage Pit(s): number of—. , size of each: ft. by—ft.
Size of Stone to be used: depth or thickness feet
Bed System Size: 5-0 -/ /0
Alternative System: 15-e rJ length andlor size 6-0 K-
6. HOLDING TANK SYSTEM: (if required)
Number oftanks: 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 RESPONSIBLE 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 make a material fact or
circumstance known by or on behalf of anapplicant,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.
Date
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TOWN OF QUEENSBUR
BUILDING
REVIEWED BY _
DATE — � i1 2p�
TOWN OF QUEE
BUILDING
NSBURY
AND CODE
o�
0 �
ar observed, or believe I saw evidence of,
�sczy ,3Uyh as houses, yells, trees, fences, etc.,
}i'tu�vrl an fibs document l also represent that l have
nallY ;MMUred the distances s forth on the diagram.'
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GNAT I hE DATE
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