97-044 BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY . No 97044
TAX MAP NO.�82 . -l-9 WARREN"COUNTY, NEW YORK .
a I'J'
PERMISSION is hereby granted to OWERS, S A.NDI
OWNER of property located at 2 JOHN CLENnnN RD, Street, Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC SYSTEM
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
PO BOX 281
LAKE GEORGE N.Y. 12845
2. CONTRACTOR or BUILDER'S Name
GRANT, DAVID
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
N/A
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( ) Steel ( )
7. PLANS and Specifications
PEPTIC NSYSTEM ALTERATION AS PER PLOT PLAN AND SPECIFICATIONS
8. Proposed Use
SEPTIC SYSTEM
$ 25 PERMIT FEE PAID -THIS PERMIT EXPIRES February 19 .19.-9-9 _
(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 19 Day of F e h rtt a ry
19 97
SIGNED BY Nv ` M+ for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT` .;�= =-{ , -ry ,,, _ - 1
1
Town of Queensbury FE 9
Dept. of Community Development Permit I o Ql
Building &Codes Office 1•Okki-: 0 P .2;`c:;:.' y !
742 Bay Road m, J�1-''< f
Queensbury, NY 12804
AAa,
Location of property for installation: !"l o u n-hi to V 1 e.cv LOA e_ i/J v An Cl en do n Rc
Property Owner's Name: Sa 4 d,, 1 v w-ere — G rc nd-
Property Owner's Mailing Address: Po• e o rc 02 8/ L a it G ec -e.t NLY.
Installer's Name: David G rG•nf Phone # 4 6 Si— i F J
Number of bedrooms (if residential): c9.. Total daily flow: 36
(residential -compute @ 150 gal./bdrm.)
Topography: / flat, rolling, steep slope % of slope
Soil Nature: ✓ sand, loam, clay, other I depth:
Ground water: at what depth?KP feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: not required, required [rate min. per inch]eq
Domestic water supply: ✓ municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet. .
PROPOSED SYSTEM
Septic tank: 1040 gallon (minimum size: 1,000 cal.)
Tile field; each trench 1'S® feet / Total system lent: I Je, feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: # / depth or thickness I feet
HOLDING TANK SYSTEM: (if required)
0
/"/ Number of tanks:it\ �,. , Size of each. gallons
f 0
K.,
_.,
•�: sys =',_ . 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 Tosin 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 by these all requirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: �," Date: 9
/1,,67)
TOWiJ OF QUEE 1SBURY
BUILDIRNG A CODE ENFORCES / - --49
531 Bay Road /
Queensbury NY 12804 /t
P 518-745-4447 /'
S. 'TIC DISPOSAL SYSTEM INSPECTION
I /!
4
Name '
Location.
Date ) a 97 Fermin # - . 'a `'
SOIL T PE ' Sand Loam-0 ay-
`.1
Resul is ''pf Percol ati orn Test-
(if appl`jcable) .Rat�f-Minute/Inch
TYPE OF :`°STEM: it -7
ABSORPTI FIELD: Total Lenfi d /J7)
Length of `,each tre ch 1 0
Depth of .enches f
Size of st ne
SEEPAGE PI Nu(ntber-
Size - v f1. x ft.
Stone size \1
PIPING: V
SiBldg. to Tank " j o Y
Tank to Dist. .;ox ,1 n
Dist. Box to F ',1 d/Pi ii II
Openings Seald.a es No Partial
LOCATION/SEPARAI-4N .
Foundation t�p�� Tan ', feet
Foundation i'o Abso ;,ption - feet
Separation f Pits '!. _ feet
Conforms as' per Pl o ►;,Plan
LOCATION or SYSTEM 0',. PROPER' No
(circle
Front - '-a, - Left Sine - Right Side
Middle .nt - Middle Rear
COMMENTS
SYSTEM USE APPROVED: NO
N. V
Arrived:
Departed:
3 gel
Building Inspector
TOM OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name )trk--"R4
Location 'gr 1 aV /A./
Date 2-r Z./�f; 7 Permit # 0 74/
SOILTYPE: Sdnd-Loam-Clay-/
Results of Percolation T st-
(if applicable) ni Rate-Mite/Inch
TYPE OF SYSTE64�c
ABSORPTION FIE4D: Total /Length
Length of each trench
Depth of trench s
Size of stone \
SEEPAGE PITS: N'mber
Size - fik x ft.
Stone size ,
PIPING: `, Size Type
Bldg. to Tank �:
Tank to Dist. Box ,'.
Dist. Box to Field//l t
Openings Sealed? . es No Partial
LOCATION/SEPARATI,INS.\
Foundation to Ta k feet
Foundation to Ab orpti n feet
Separation of P is feet
Conforms as per Plot P1 1 Yes No
LOCATION OF SY TE 1 ON PR PERTY:
(circle one)
Front - Rear Left Side - Right Side
Middle Front Middle Rear
COMMENTS:
47-- &A-6\
SYSTEM SE APPROVED:3 -- .
YES
Arrive '
Depar ;
,4,/__
Building Inspector
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