97-189 BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 97189
TAX MAP NO. 127 . —2-7 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to FLANSBURG, JAMES II &
OWNER of property located at 53 MICHIGAN AVE. 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
CYNTHIA 53 MICHIGAN AVE.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
SMITH, FRED
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by XI
SEPTIC
( 1 Wood Frame ( ) Masonry ( 1 Steel ( I
7. PLANS and Specifications
SEPMC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES May 2 1g 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 2 Day of May 19 97
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
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._... . Anplicatioii tor .
•SEPTIC DISPOSAL PERMIT
STAMP RECEIVED
•
Location of properix for Installation: M, .. .;FINED
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Owner's Name: 3� ./Pn cb✓e- y' MA 0�•^ o j t
3 /it1/seon �&1 Ale' . • Y( r t
Address: tU�,;��
, � 1 IBUILI�ING�AND CO!' _
Installer's Naure: ll: i�niu
Phone #: (of), 7� SJ k3
Number of bedrooms (if residential):
Total daily flow (residential -compute ail 150 gal. per bedroom):
Topography: . [ 'plat .1 i Rolling ri Steep Slope % of Slope
Soil Nature: FA Sand • r] Loam El Clay 0 Other /Depth:
•Ground Water: at what depth? • feet
Bedrock or lnrper*us Material: at what depth? • feet
1
Percolation Test: L Not Required I-1 . Required/Rate min. per inch
' Domektic Water Supply: 'I Municipal (-1 Well [- 1 Other
If domestic water supply is a WELL: water supply from ally septic absorption is feet .
• 4.4 is 77n
l'ROI'OSIsl) SYSTEM: /
Septic lank:'.f.I�"- •gal. (minimum size: .1.000 gal.) •
'lilt Field: each trench 3--/ , feet. / total system length OW feet.
Seepage I'il(s): number of ' / • size each: ft. x ft.
Size of stone to be`used: # � depth or thickness feet.
11Ol..DINU TANK SYS'1'1?M: (if required)
Number of tanks: : :. • Size of each: gal. •
11,- 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 u pon or is granted in reliance upon
f ,
any;material misrepresentation or failure to make a material fir et or circumstance known by or on
beltnl f o f an iirrlico► t, sit till be void.
1 have read the regulations with respect to this application and agree to abide by these and all
\ requirements of the Town o f Queensbury ,Sa ' ary S, rage Disposal Ordinance. •
i. . y
S e,g.vvre o f r•.esponsVe person: ��, Date:
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TOWN OF QUEENSBURY )
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804 •
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 3 :c \; (�Y %'Th
� 1 \1
Location „
Date l-, -�l� 1 (.
j ? P-rmit # —/
SOIL TYPE SandLoa -Clay-
Results of Percolat on Test-
(if applicable) Rat:-Minute/ nch
TYPE OF SYSTEM:
ABSORPTION FIELD: To al Length ` 7
Length of each trenc . L . AO
Depth of trenches _
Size of stone -♦-
SEEPAGE PITS: Number 7� `— c>
Size - ft. x ft. �
1,41
Stone size
PIPING: Size Type CM
Bldg. to Tank
Tank to Dist. Box e' BUG
Dist. Box to Field/Pit " p -VF
Openings Sealed? 40 es No Partial
LOCATION/SEPARATI :
Foundation to TankE)4615. t, 3 feet
Foundation to Absorption 5 feet
Separation of Pi -! feet
Conforms as per 'lot Plan Ye No
LOCATION OF SYS ' M ON PROPE'�
• (circle one)
Front - Rear - eft Side - Ri .ht Side
Middle From ale Re r�
COMMENTS:
SYSTEM USE APPROVED: c NO
Arrived: -00
Depar .
Building I ector
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is
PLOT PLAN
SEPTIC SYSTEM
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' 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
��X1�b those plans for your signature.
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TOWN OF QUEENSBURY BUILDING DEPARTMENT
Based on our limited examination,
• compliance.with our comments shall '
not be construed as indicating the 5-3
plans and specifications are in full
compliance with the code.
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Po 40
TOWN OF Q UEENSBU Y "I have seen or observed, or believe I saw evidence of,
I all objects such as houses, wells, trees, fences, etc.,
U I LD 1 NG C C 'k":ik )EP T, shown on this document I also represent that I have
q[�� t�,J) hh-- personally r .asured tl- distan s set forth on the diagram."
DATE IVED
c7 Z 97 SI 'NIIILIRE ME