97-236 BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 97236
TAX MAP N0. 82 . -6-25 WARREN COUNTY, NEW YORK
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P S Y granted to
CAFARO, MADGALENA
14 DORSET PLACE Street.Road or Ave.
OWNER of property located at
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. oWWEf6s Acldris 4165
QUEENSBURY,t NY 12804
2. CONTRACTOR or BUILDER'S Name
SMITH, FRED
3. CONTRACTOR or BUILDERS Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) SEPTIC
( )Wood Frame ( I Masonry ( 1 Steel 1 )
7. PLANS and Specifications
SEPILIC ALTERATION AS PER PLOT PLAN SPECIFICATION
8. Proposed Use
SEPTIC ALTERATION. .
25 May 15 99
$ 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.)
15 May 97
Dated at the Town of Queensbury this Day of 19
SIGNED BY for the Town of Queensbury '
Building and Zoning Inspector
i
--- .I phlicatiou for
SEPTIC'"DISPOSAL PERMIT
SIAb RECEIVED
Location of property for Installation: V�i'�5ie Ic —
/�//y�� PERMIT NUMBER
Name: a 69. JDd] (i rA1CO
Address: / �r)tPst'� 7` ' 1 ct . "aL3
installer's Name: . Sill/ph I l;ti )'AID 5 ao.
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• Phone #: (s'7) 7q 8i 1<3 6
Number of bedrooms (if residential): `3
Total daily flow (residential -compute 01.1 150 gal. per bedroom): 510
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Topography: hlat I 1 Rolling I-1 Steep Slope 4t, of Slope
Soil Nature: Sand n Loam [-) Clay I-i Other /Depth: _
Ground Water: at what depth? i - feet
, 1 MAY 15 1997
Bedrock or lnt pery ous Material: ht what depth? • feet
p ;i 1 TOWN OF QUEENSOURY
Percolation Test: r' Not Required �E . Required/Rate min. per Inc
BUILDING AND CODE
' Domei;tic Water Supply: Municipal (-1 Well 1----1 Other
i
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If domestic water supply is n,WF.1.1. water s'uppiy from any septic absorption is feet
PROPOSED SYSTEM:
lS�T6
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Septic'tank: /�,' gal. (minimum size: .1.000 gal.) •
1
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Tile Field: each trench • feet. / total system length feet.
Seepage PRO): number of _ / size each: ft. x ft.
Size of stone to be,used: # 3 / depth or thickness feet.
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IIOI..DING 'TANK SYSTEM: (if required)
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Number of tanks: . . Size of each: gni.
II
I1— Alarm system aird associated electrical.work to be inspected bye certified agency.
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For your protection, plea}e note that pursuant to Section 136-29 of the Code of the Town of
Queensbury, any permit oh approval granted which is based Upon or is granted in reliance upon
c. ..;
any material misrepresentation or failure to make a nrater•inl first or circumstance lcnorrrr by or on
behalf of am applicant,• shall be void.
1
I have read the regulations with respect to this application and agree to abide by thesis and nil
ti requirements of the Town of Queensbury nitar Sewage Disposal Ordinance.' '
I I?"
,Signature o,f r,esi
po t,sible person: i 4 Date:
r 1 oy
• r!n
. .A
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804 \U--- (--M\
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name Y �'
Location
Date 1-1 Permit # C) f e G7
SOIL TYPE: S✓ am-Clay-
Results off Perc®1ation Test-
(if applicabl - Rate-Minute/Inch
TYPE OF SYST
ABSORPTION FELD: Total Length
Length of e.ch-trench
Depth of t tenches
Size of stone
SEEPAGE PITS: Number-
Size - ._ ft. x 1c) ft. v.:1 v_;4:_E-
Stone size .?5
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Drst. Box to Field/ FOIC
Openings Sealed? No Partial
LOCATION/SEPARATIONS:
Foundation to Tank V4peTfeet
Foundation to Absorption 3(*--feet
Separation of Pits 7,rfeet
Conforms as per Plot Plan Yc‘No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Fronts e ,
COMMENTS:
SYSTEM USE APPROVED: YE NO
Arrived: Vr'N
Depar ed: '
wilding I for
�► ` ��
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MAY 15 1997
PLOT PLAN
SEPTIC SYSTEM TOWN OF OUEENSOUFtY
BUILDING AND CODE
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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W re-IL ' ;Si Ay
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TowN Qu r u y Buy , Q� f, ; �. "I have seen or observed, or believe I saw evidence of,
j q' . � n all objects such as houses, wells, trees, fences, etc.,
REVIEWED CY shown on this document. I also represent that I have
personal easu d the distances set forth on the dia ram."
/691 OZ/g7
SIGNATURE DATE