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97-132 BUILDING PERMIT VALUE $ 0 TOWN OF QUEENSBURY No 97132 TAX MAP NO. 143 . —1-1 . 2 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to KIERNAN, AUDREY & RUMPF , OWNER of property located at 155 BIG BAY RD. 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 JEFFREY 155 BIG BAY RD. QUEENSBURY, NY 12804 2. CONTRACTOR or BUILDER'S Name CONDON'S SEPTIC & DRAIN 3. CONTRACTOR or BUILDER'S Address 0 4. ARCHITECT'S Name 5. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) SEPTIC ( )Wood Frame ( ) Masonry ( )Steel ( ) 7. PLANS and Specifications SEPToIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS 8. Proposed Use SEPTIC ALTERATION April 14 99 $ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES 19 (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.) 14 April 97 Dated at the Town of Queensbury this Day of 19 SIGNED BY for the Town of Queensbury Buildin and Zoning Inspector Ir Application for SEPTIC DISPOSAL PERMIT Town of Queensbury Permit No. e — Dept. of Community Development Building &Codes Office 742 Bay Road Fee Paid $ Queensbury, NY 12804 L _ J Location of property for installation: /9 1Pf,Q.S / r /u7 /t 2 Property Owner's Name: /9v J7 rc l P l F YN.S►it> Property Owner's Mailing Address: I is— 2iy ?Ay Acic Installer's Name: ( iid6bvs SFj.�.-f� c!4 t r/i) Phone # 79r 0 - y Number of bedrooms (if residential): 3 Total daily flow:. 11 5( (residential - compute @ 150 gal./bdrm.) Topography: y flat, rolling, steep slope % of slope Soil Nature: y sand, loam, clay, other /depth: Ground water: at what depth? A/A-feet / Bedrock or Impervious Material: at what depth? et Percolation test: not required, required, [rate min. per inch] Domestic water supply: y municipal, well, other If domestic water supply is a WELL, water supply from any septic absorption is feet. PROPOSED SYSTEM Septic tank: tu-r1) gallon (minimum size: 1,000 gal.) Tile field: each trench ._(-0 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 Alarm system and associated electrical work to be inspected by a certified agency. • 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 Ordinance. / Q f Ckn4Y\ Signature of responsible person:�K / Date: - f Application for SEPTIC DISPOSAL PERMIT o • SI'AMI' R1.sCl;l Vl:l) Z Location of property fur installation: 17 f COW/ golf O Owner's Name iefU.DiZey id/�r12Aw l'RltMI•T NUMIIIiR Owner's Mailing Address: /sr a7 IJ Ad, Q. 7-/3 - - Installer's Nante:C)ft��tV S SipP¢iC_ Phone #: 7*-8-xy2-- to Number of bedrooms (if residential): 3 • ECG VEi Total daily flow (residential -compute fit 150.gal. per bedroom): ) 6 Topography: Flat Q Rolling �� l 1 `OF GIUEE SL,.URY 1 IXSteep Slope 3'noC��c�1L`lll*AND CON Soil Nature: 1X1 Sand 1 Loam Clay Other /Depth: Ground Water: at what depth? ��A feet Bedrock or Impervious Material: at what depth? -- ��r feet Percolation'lest_: [1 Nut Required I I Required/Rate min. per inch Domestic Water Supply: CX Municipal I I Well [] Other If domestic water supply is a WELL water supply from any septic absorption is feet I'ROI'OSIiI) SYSTEM: It2 pia.,64,7c-4 Mad terag w/iv244) .6)6T1u6v r U 42 7c Septic tank: As?" gal, (minimum size: 1.000 gal.) ' ' Tile Field: each trench feet. / total system length feet. . Seepage Pil(s): number of / size each: ft. x ft. - Size of stone to be used: # / depth or thickness - feet. IIOI.,DING 'TANK SYSTEM:M: (if required) - Number of tanks: • • Size of each: gal. • • - . . .. . liaTh Alarm .system and ascociate.d electrical work to be inspected by a certified iigency. For your protection, please note that pursuant to Section 136-29 of the Code o f the Town of Qaeensbary, any permit or a p prot'ul granted which is based a poll or is granted in.reliance a pun . any material misrepresentation or fcrihrre to make a material fret or circumstance known by or on behalf o f 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 Ordinance. Signature of responsib'c person: [. . Date: Y---7./-P? { \` \J f j n o„L-\--, ; W- `'---c.C�4TOHN OF QUEENSB BUILDING & CODE ENFOR EMENT // 531 Bay Road Queeisbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name y{, p Y,,,D,,,, ) y-e Location ' �Q�O fi PJ Date 7 - e rm i t • .'• --/ 3 a SOIL TYPE: Sind-Loam- lay, Results of Pe-§co ation rest- (if applicablRate-Mi ute/Inch TYPE OF SYSTE: 1 ABSORPTION FIE D: Total Lenh° Length of each �trenc I J Depth of trench s Size of stone 'Z,i SEEPAGE PITS: NTmb r- Size - f /x ft. Stone size \E PIPItdG: A 9 Si�e Type �� Bldg. to Tank . Tank to Dist. Bo> \ a 0 Dist. Box to Field/ t w V Openings Sealed?`' No Partial LOCATION/SEPARAjIO Foundation to Tank /Q feet Foundation to bsorpti . �,� feet Separation of pits feet Conforms as p r Plot Pl al � No LOCATION OF STELA ON PRE:"ERTS : (circi on: Front Rea : - Left Side Right Side Middle ont� - Middle Rear COMMENTS: /// SYSTI USE APPROVED: YES A Arri ed: a Depa ed: Building Inspector ' - r 1 have seen a observed,or believe f siw evidence of, all objects such as houses„wells,try fences,.etc,, , shown on this document I also represent that I have personally measured the distracts set forth on the diagram." 'OWN OF UEE` de A!_l ,7 j .D `' `; .r S . SIGNATURE DATE REVIEWED BY • "? DATE '.l 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. TOWN OF QUEENSBURY BUILDING DEPARTMENT FtE1-1 i Based on our limited examination, - r • compliance with our comments shall A. 'tt197 not be construed as indicating the PR FX plans and specifications are in full " V compliance with the code. o f i I '�� :- ,�; • Pelobl-cE Peot- pil kr . W r- H WEc , ta-16 (own-c°'£ -36 P r iv V4uf -- //CO ( U ex, sf►vt/�r f A i;a-c-H Fr i l I � co- % ., re-r ,..LL " 32.PA 'fi . , ,r,.:C Al 7_, _A c:.1: r :asz_:a;s rt1:A r A_,..-:1 1_. _ :_ 44, ` f sheer _- tool, r - .- 1_1= ' J • "I have seen or observed.or believe I sew evidence oI all objects such as houses,mist tresso ferIMM elo.. shown on this docment.I also represent that I bud personally measured the distirnoes set forth ow the dream." Ati/J6 . 1277-7, // SIGNATURE 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. "I have seen or observed,of believe I saw evidence of, all objects such as houses,wells,trees,fences,etc., • shown'on this document I also represent that I have personally measured the distances set forth on the diagram." `5 b z SIGNATURE DATE e.4) TOWN OF QUEMISBLEVe sor p p N REVIEWED BY \\, ©i \ Euj Co A/W({ DATA 4 1 c 0-r° 3 � FILE COPY • • TOWN OF QUEENSBURY BUILDING DEPARTMENT. . Based on our limited examination, ' compliance with our comments-shall - • not be construed as indicating the plans and specifications are in full compliance with the code. • __ 17 peAC5/aiq �°�r