97-253 BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 97253
TAX MAP N0. 72 . —5-1 WARREN COUNTY, NEW YORK
c`lUb WINCHELL, ROBERT
PERM! IOltf t1 eby granted to
OWNER of property located at 23 GREENWAY NORTH 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
23 GREENWAY NORTH
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
QUEENSBURY SEWER
3. CONJTaC SWEET BUILDER'S Address
0 .
4. ARCHITECTS Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( )Masonry ( )Steel ( )
7. PLANS and Specifications
SE$,EIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 May 22. 19 99
$ PERMIT FEE PAID —THIS PERMIT EXPIRES
(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.)
22
Dated at the Town of Queensbury this Day of May 9 7
19
SIGNED BY ,�ti 7,1A ',f5 4 L iV\< for the Town of Queensbury
ilding and oning Inspecto
Application for SEPTIC DISPOSAL PERMIT
(Town of Queensbury Permit No.C) C2
! -,2 J
Dept. of Community Development
Building &Codes Office p p
742 Bay Road Fee Paid $ 5-,
Queensbury, NY 12804
J
Location of property for installation: j Y e e n co s,v ,u o
Property Owner's Name:k I2.- c, Y PI (A..) 1 rt c L't I
Property Owner's Mailing Address: _ 6.' rr e / v-,i.--1 -4 Co--r-4 4-o- fi,/
Installer's Name tk,p e l S m c Phone # / I ` d 3 CV oci
Number of bedrooms (if residential): a Total daily flow: �
(residential -compute @ 150 gal./bdrm.)
Topography: /\ flat, rolling, steep slope % of slope \I
Soil Nature: sand, loam, clay, other/depth: MAY 2 21997
Ground water: at what depth? feet / Bedrock or Impervious Material: at idpfih?JuE feefoRY
l BUILDING AEI D CODE
Percolation test: y -not required, required [rate min. per inch]
Domestic water supply: municipal, well, other
If domestic water supply is a WELL, water supply from any seetic absorption is feet.
PROPOSED SYSTEM
Septic /'"V gallon (minimum:;size: 1,000 gal.)
Tile field: each trench . /- feet / Total system length: / 3 S— feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used:. # `4' / depth or thickness /o `" feet
•
HOLDING TANK SYSTEM: (if required)
•
Number of tanks: Size of each: gallons
r
Alarm 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 wail_
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 Dispos Ordinance.
( 6Signature of responsible person: Date:3 e7/' T 7
TOWN OF QUEENSBURY �
e__,--BUILDING & CODE ENFORCEMENT /
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name f 2 - 1- k.)1`(1
Location s ( A (t
Date SAZ-Z= Permit # °[7
SOIL TYP: : SandiLoam-Clay-
Resul of Percolation Test-
(if aiplicable) Rate-Minute/Inch if
TYPE OF SYSTEM: i /
ABSORPTION FIELD Total Lgyrgth/ /35
Length of each t e 0,1
Depth of trenc .4 /
Size of st. e �� r
SEEPAG 'ITS: Nu°ber- �
Si - - ft. x ft.
one size
'IPING: Size' Type .
Bldg. to Tank /✓u,
Tank to Dist. Box 441/ 5e9 0O
Dist. Box to Field/P
Openings Sealed? lNo Partiat
LOCATION/SEPARATIO .
Foundation to Tank " feet
Foundation to Absorpti ®feet
Separation of Pits feet
Conforms as per Plot P1 n dor. No
LOCATION OF SYSTEM ON PROPER :
(circle IiL '`o'
Front - - Left Sid:4 R ght Sid-
Middle Front - Middle;Re.
COMMENTS:
•
SYSTEM USE APPROVED: YES NO
Arrived:
Departed: 9rip-
Building Inspector
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have seen or observed,Or G.- begsvet 41,00111-10.01t ' i,) • , ,..
all objects such as houses,wells,uneconnow,
shown on this document.I also ropro40411041*.
e ovally measure the distan.- aeti.flklliktinXllgram•
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AunN7nr)lo mmoi FILE COPY
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I TOWN OF QUEENSBURY BUILDING DEPARTVIEN1
Based on our limited examination,
5 e-L1 fN compliance with our comments shall
not be construed as indicating the
( plans and specifications are in full
--) compliance with the code
in