97-060 BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No.
970G0
TAX MAP NO. 121 . -12-201 .
31)
WARREN COUNTY, NEW YORK
SIO�lisiiereb
PERM -AY.'3 I
Y granted to QUEEN VICTORIA GRANT
OWNER of property located at MARGARET DR. Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC ALTERATION
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
HOMEOWNER'S ASSOCIATION MARGARET DR. BOX A
QUEENSBURY,NY 12804
2. CONTRACTOR or BUILDER'S Name
I. B. S. SEPTIC
3. CONTRACTOR or BUILDER'S Address
2 LOWER WARREN STREET
QUEENSBURY, NY 12804
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( ►Wood Frame ( ) Masonry ( )StPerrTS
7. PLANS and Specifications
SEPTIC NgiLTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES March 3 19 99
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 3 Day of March 19 47
SIGNED BY
for the Town of Queensbury
Building and Z Wing Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No. 'moo O
Dept. of Community Development
Building &Codes Office O o
742 Bay Road Fee Paid $ LL
Queensbury, NY 12804
Location of property for installatioN• 1-- // 0,...„ti e ,-% /`,,,,r Jr,`v
Property Owner's Name: 0 cJ e t n Vi C/of. g t,�7 /o' O G.,Atrf 4SSo C,
Property Owner's Mailing Address: `/ ,
Installer's Name: , ,De ft. ,cf / / 6 Phone # 79K vJ c/
Number of bedrooms (if residential): Total daily flow:
(residential - compute @ 150 gal./bdrm.)
Topography: () flat, rolling, steep slope % of slope
Soil Nature: d, loam, clay, other /depth:
Ground water: at what depth?feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation testl not required, required [rate min. per inch]
9
Domestic water supply: municipal, well, ()thy_
If domestic water supply is a WELL, water supply from any sec absoiptio:',1:11 : et. .
PROPOSED SYSTEM r %. AMR .0 3 l99?
��S
Dva gallony r&�l,,::;:�: •Septic (minimum size: 1,000 gal.) �. 1•..e z...: ,
-__ --�ii,ec., : s=-/
Tile field: each trench feet / Total system length: feet
Seepage pit(s): number of / size each: ft. by ft.
/____
Size of stone to be used: # / depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
CAl1 system and associated electrical work to be inspected by a certified agency.-\ •
J
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 Ordinal 9
Signature of responsible person: �; Date: ) —3 e/ 2
"I hire seen or obsefred,a<bstis+ro 1 snr eridsoce o�
JO() all objecle such as tee,,r s t fs&s&di,
shown on this domed.I s ss rimed est 1 hoe
personalty the set , on the "
R �31997
VIA 01 k 'GNATURE DATE
1 L,•
p `S
PLOT PLAN
SEPTIC SYSTEM
Notices The following statement must be "stamped" on your plot
plan. This sheet of paper may be used for purposes of drawing your
plot plan. After drawing such plot plan, please read the statement
and sign it. If you choose to use other paper for your plot plan,
the office will stamp those plans for your signature.
•
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TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
/0
Name (..l'f/ C C . 64 7'
•
Location
Date Permit # 47;7',649 .
SOIL TYPE: San. Loam-Clay-
Results of Percolatio- Test-
(if applicable) Rat--M'nute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD; Tot.l Length
Length Of each ' ench
Depth of tre°che•,
Size of s .ne
SEEPAG 'ITS: Number-
Si - - ft. x ft.
Stone size
PIPING: • . Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption _ feet
Separation of Pits feet
.Conforms as per Plot Plan Yes No .
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear .- Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
&& v6 .4w-6-/IA /MO�rf-�
. fk(n4J 4,/.. aK 0 g
SYSTEM USE APPROVED: NO
Arrived:
Departed: •
Building Inspector
03;'13/97 09:0r F1 V 001
•ON STATE OF NEW YORK
DEPARTMENT OF HEALTH
75`. .jy)'7
Office of Putgic Neagh Gens Fails District Office 77 Mohican Street Gens Falls.New Yak 12801 (518)753-8893 FAX(518)793-0427
Barbara Odiuono,MD..MP-H.
Commissroner panne Whalen
Executive OeputyCommisstoner
1
1\ii,14.\[@1
MAR 12 1997
Toby;; c
TO:
•
•
FROM:
®ATE: 2 - �7
PAGES TO FOLLOW:
Please call (518) 793-3893 if there are any problems with receipt of
this transmission.
MESSAGE: v�, -ArpI41NN6' GF,,
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TOEN OF QUEENSBURY
BUILDING Si CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name aG-c:A) ()LC . e2,¢AJ j
Location
Date 3/7("2 Permit # 7— 06E
SOIL TYPE: an. Loa - lay-
Results of Percolat'o est-
(if applicable) Ra -M ute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total ,Longth
Length of each trend : 27cp qo'C�A'
Depth of trenches
Size of stone . qi
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank 6 /51 l A't./
Tank to Dist. Box C," 50g- 35
Dist. Box to Field/P'y nV /.0
Openings Sealed? ft0 No Partial
LOCATION/SEPARATIONS.
Foundation to Tank ✓q feet
Foundation to Absorption -' feet
Separation of Pits feet
Conforms as per Plot Plan in No
LOCATION OF SYSTEM ON PROPE"
(circlea
Front - - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
IRDUu . CNCoINcG-S 2/Rot1-JL
rok D6--y9-0*
Dc
/kJ , C.o UC i
SYSTEM USE APPROVED: YES P10
Arrived: /- JD
Departed: li
��D
Building Inspector
rg-9/ C1 5Go(/
TONN OF QUEETISBUR;'
BUILDING A CODE WORCEMEMT
531 Bay Road
Queensbury NY 12804
518--745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name �lt C S
Location 3 `'7� lje /4&
Date 3nq 7 Permit #
SOIL TYPE: Sand- oam-Clay-
Results of Percol c.'- • Test-
(if applicable) RP !inute/Inch
TYPE OF SYSTEM
ABSORPTIOX FIELD: Total Length
Length of each trench
Depth of. trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION,/SEPARATIMS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits _ feet
Conforms as per Plot Plan Yes No
LOCATION+] OF SYSTEM OZ PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
C',� ccoo uL-C- I'�c—()1
allg 0
L0c �;,v�S
SYSTEM USE APPROVED: YES NO
Arrived: / C
Departed: r �p
Building Inspector
'I
% — all objects such as houses,wells,trees,keels,eto.0
t shown on this
. 1., r; f dopwt I also that I here
a_ ; ,R _ ;-- personally . � the . • se! , oN Oe "
0 3..199� ./, / 3-3Y?
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��A 11:0 \ 401.-- -4 GNATURE • DATE
PLOT PLAN
SEPTIC SYSTEM • '
Notice: The following statement must be "stamped" on. your plot
plan. This sheet of paper'may be used for purposes of drawing your
plot plan. After drawing such plot plan, please read the statement
and• sign it. If you choose to use other paper for your plot plan,
the office will stamp those plans for your signature.
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TOWN ®� r n
UEENSBUR :.
BUILDING „Of- i Tzi.. �,
REVIEWED BY • ,
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v ,.,,,-_ DATE ,
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