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97-229 BUILDING PERMIT VALUE $ 0 TOWN OF QUEENSBURY No. 97229 TAX MAP NO. 109 . —5-9 WARREN COUNTY, NEW YORK ✓� o I RICIA PERM ISSION is hereby ranted OTHMER, PAT OWNER of property located at 200 QUEENSBURY 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 Oueensbury Building and Zoning Ordinance. 1. OWNERS Address is 200 QUEENSBURY AVE. QUEENSBURY, NY 12804 2. CONTRACTOR or BUILDER'S Name COOKS SEPTIC 3. CONTRACTOR or BUILDERS Address 12.801 4. ARCHITECTS Name 5. ARCHITECTS Address 6. TYPE,of Construction—(Please indicate by X) SEPTIC ( 1 Wood Frame ( 1 Masonry ( 1 Steel 1 1 7. PLANS and Specifications SET1bTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS 8. Proposed Use SEPTIC ALTERATION May :,15 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.) 15 May 97 Dated at the Town of Queensbury this Day of 19 SIGNED BY çA)-CSkti '\cr.r for the Town of Queensbury Building and Zoning Inspector Application for SEPTIC DISPOSAL PERMIT 9., 1) Town of QueensburyDept. of Community Development `0 Permit No. --);--,7 Building &Codes Office 6 57—L /� 9 (fC1 742 Bay Road Fee Paid $, �, Queensbury, NY 12804 1 L J _ Location of property for installatign: 700 C E4.S,C44.-- �,,.., .. 1 Property Owner's Name:/ i2r ✓% /a? /�' - Property Owner' ailing/ Address: `Installer's Name: - S �c l& Phone # 7 2 c5-/ '. Number of bedrooms (if residential): 3 Total daily flow: (residential -comp,to % ` _. . Topography: flag: rolling, steep slope % of sl.p- mriY 141997 • Soil Nature: (/sand, loam, clay, other /depth: TOWN OF QUEEN 3URY UILDING AND CODE Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? feet Percolation test: not required, required [rate , min. per inch] Domestic water supply: municipal, - well, other If domestic water supply is a WELL, water supply from any septic absorption is i feet. PROPOSED SYSTEM . Septic tanlc /©Qt gallon (minimum size: 1,000 gal.) Tile field: each trench ‘b feet / Total system length: ' /17 feet r Seepage pit(s): number of — / 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 Cmi 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 void. I have read the regulations with respect to this application and _ to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.Signature of responsible person: / C. ,,,C Date: • TONW OF QUEENSBURY . BUILDING A CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name -714HEB Location Z_b® A _ k)17),` M Date ��TAJ !' / Permit # qi.-77q SOIL TYPE( San'doam- 1 ay- Results of Perc"o1a io Test- "(if applicable) \Ra e;Minute/Inch TYPE OF SYSTEM:- 1 / ABSORPTION FIELD: otal Length (I t9 Length of each tench •Z C� t ' 0 h-Ti Depth of trench s •�, -c,n': Size of stone tJ►)13E SEEPAGE PITS: umber- Size - ft. t. Stone size PIPING: 16 Size Type Bldg. to Tank Fy,6T C.,, a yo Tank to Dist. Box yip; Pq c Dist. Box to Field/ 1t.) L Openings Sealed? - No Partia LOCATION/SEPARATION : Foundation to Tank I d+. feet Foundation to Absorption -jTh+ feet Separation of Pits feet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PROPERTY: • (circle one) Front - Rear - Left Side Ri ht Side Middle Front - widdle 'ear COMMENTS: --1 - ' G„ Fillil SYSTEM USE APPROVED: YES Arrived: De ar. •- jrAI; /,...L,c kif / :ui1ding In 4 .1, tor TOWN OF QUEENSBURY ,dr,-- )1). BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name c.D .%-..,4-Nc\sa -.1)j Ci '')('.�l R 4Location o)Q0 Qtj2 q',v�C�(1 !�U'� Date 'a,7-9'/ Permit # 1(—D SOIL TYPE: Sand-Loam-Clay- Resul is of Per l ati ,) Test- (if applicable) R,ate :Minute/Inch TYPE OF SYSTEM: +` ABSORPTION FIELD: T 'tal Length Length of each trenoth Depth of trenches Size of stone. SEEPAGE PITS: Number- Size - ft. x ft. Stone size PIPING: Size Type Bldg. to Tank Tank to Dist. Box Dist. Box to Field/Pit Openings Sealed? Yes No Partial LOCATION/SEPARATIONS: Foundation to Tank feet Foundation to Absorption _ feet Separation of Pits feet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: ' — b.(\ '' SYSTEM USE APPROVED: YE :2t::D') Arrive. `ems < Depa; . _P •ui :7ing I p:ctor TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 • 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name V _IF. E PI:;-i-PALIA Location 2 C) (--- __OE E -4- 0g, )E Date 517197 Permit # G j-Zzc-1 SOIL TYPE: Sand-Loam-Clay- Results of Percolation Test- (if applicable) RaiteMinute/Inch TYPE OF SYSTEM: ABSORPTION F LD:, Totl Length Length of eacct�tench` Depth of trenches' Size of stone ,'j SEEPAGE PITS: ,',`,Number- Size - ft. x ft. Stone size PIPING: Size Type Bldg. to Tank Tank to Dist. Box Dist. Box to Field/Pit Openings Sealed? Yes No Partial LOCATION/SEPARATIONS: Foundation to Tank feet Foundation to Absorption feet Separation of Pits _ feet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: WcT REkp . SYSTEM USE APPROVED: YES NO Arrived' : -r Depar'ed- . I_ /i Building spector e) r TOWS OF QUEENSBURY Dy BUILDING & CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 . • 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name Paltathi. &J , ,d Location doe) xt4 ., Date )q-1 Permit #,ii-- 2 SOIL TYPE•�-San�Loam-C1 ay �nResults oflprco o est- (if applicable) Rate-Mi;hute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length \ T Length of eachktrench' Depth of trench' s t r Size of stone \ i VICE SEEPAGE PITS: Ni)mt5er- Size - ft ` x ft. Stone size ' PIPING: AY \ Size Type Bldg. to Tank ! ,i o Tank to Dist. B o,� `cE.E�CRQ'�l Dist. Box to .'i• ���` Openings Seal ? Yeas ��No�Parrtt e� ed LOCATION/SEPAITIONS: Foundation to, Tank ‘Q, feet Foundation tti' Absorption • feet Separation of Pits Conforms as/per Plot P1 an \ Ye o ; LOCATION OF SYSTEM ON PROPERTY:R • (circle one) Front - Rdar — Left Side light Side Middle Front - 'i ddl a Rear 7 - COMMENTSI \ g i V{N‘K\ i . : E. TEM-�SEAPRaYiD:per NO Arrives. Depa ed ,mg .ft,411" AX & %u11ding I':p: or Mk SI)M TOM OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION c:) Name /�-,CA Location ..),(5 o )P�'A,S c-Ve._, Date ,-'J&9 7 Permit #Q� 4` SOIL TYPE: Sand-Loam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length Length o e.oh trench Depth of t '-niches Size of st) ,e\,. SEEPAGE P ' \ Number- Size - 1 ft. x ft. Stone s'ze PIPING° Size Type Bldg. o Tank Tank to Dist. Box Dist. Box to Field/Pit Openings Sealed? .. Yes No Partial LOCATION/SEPARATIONS: Foundation to Tank \ feet Foundation to Absorption feet Separation of Pits feet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: P,WG (?..._0 \).djV___ -To P t31, 1 1,3 e gam. oc o_ EV • b Q-1?__‘ -`i v-1-- V=AQ-5A __v_b---ci\t31(-- N (� v-vL� b3‘\,Lv �u-. v p SYSTEM USE APPROVED: YES 0 -= er Arrive.- `ili% ,r. C 0� .� E- Depa, ed L Lo F-ti /A Y /�/ :'ilding I •ctor TOWN OF QUEENSBURY BUILDING A CODE ENFORCEMENT 531 Bay Road Queensbury WY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name Location 7LUF= ,{����� Date L i I5)97 Permit # (17—qZ9' SOIL TYPE: Sand-Loam-Clay- Results of Per. ol .tion Test- (if applicable) ' .te-Minute/Inch TYPE OF SYSTEM:. ABSORPTION FIEL►.': Total Length Length of eac t ench Depth of tre ches Size of stone SEEPAGE PITS: Number- Size - ft. x ft. Stone size PIPING: Size Type Bldg. to Tank Tank to Dist. Box Dist. Box to Field/Pit Openings Sealed? Yes No Partial LOCATION/SEPARATIONS: Foundation to Tank feet Foundation to Absorption feet Separation of Pits _ feet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: f. .20.; • oe-vE:I7) SYSTEM USE APPROVED: YE Arrived: 4 Depar tip Building .ns7.- or ? 4'e.e_e//7,2C/ry TOWN 0 E FINAL INSPECTION CERTIFICATE • PROPERTY TAX MAP NO. l o "—E— ?- • ie ,--( 1\, • • o� 4F� tit / cp I 69 (5 igy /m-� /l _r 1 es • _ a rll�Ury c • _ , c �,i , S A-v ' 1 jci7t, s rl l 1 1 • The above sketch shows the locations.of the units comprising your sewage disposal system for future reference in case of difficulty. It shows measured distances from buildings, trees, garage, fenceposts, etc. , to the components of your sewage disposal system. c CONSTRUCTED BY: �.� DATE INSTALLED: DESIGN BASIS • 1 . No. of bedrooms: 5. Septic tank: type c��-4 • Cam` 2. Daily flow: _ gpd capacity __ gals. ' . 3. Undisturbed soil depths: 6. Size of leaching device: / 7 ft. a. . To groundwater: • 7. Type of system (conventional , fill , b. To• impervious len etc. ): 4. Percolation rate: 5 min/in. APPROVED BY: DATE: f, .. ,•, -: ����Fn r d'•T:: 1 �-;3 2C `2,r, 3 La MAY 14. 1997 REVIE`!ED BY /' cA--- - - '. TOWN Or �aVtaiN fesURY -- � BUILDING AND CODE DATE