97-430 BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ @ No 97430
TAX MAP NO. 96 . —1-12 WARREN COUNTY, NEW YORK.
PERMISSION is hereby granted to CULVER, EVFT.ybT -
OWNER of property located at 315 DIXON RD_ Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC ALTERATION
at the above location in accordanceto 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,
189 DIXON ROAD
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
MAILLE, W.W. EXCAVATING
3. CONTRACTOR or BUILDER'S.Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( 1 Masonry ( 1 Steel (
7. PLANS and Specifications
SEPT/V. ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES August. 1 "`. 19 99
Of a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Oueensbury.before the expiration date.)
1 August 97
Dated at the Town of Queensbury this D y of 19
SIGNED BY S?\/- t CJA(\ for the Town of Oueensbury
Buildi nd Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
/ -7777Town of Queensbury i . it_ 1)
Dept. of Community Development Permit N.
Building &Codes Office JUL 2 J 1°Q7
742 Bay Road Fee Paid IJ Queensbury, NY 12804 / d
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Location of property for installation: 3 15 ) i X o do o o ci
Property Owner's Name: Ev I Cu \ver-
Property Owner's Mailing Address: 31 S i Xc 'n Ra. Q Uet ns�Uv l) l I Zg��
Installer's Name: U3-u� . C-61 C \\ L X c o U ozVn Q Phone # S18� �I -��0 0'n
Number of bedrooms (if residential): 02 Total daily flow: S 0 O cA
(residential - compute:@ l ;.gal:/bdrm.)
)
Topography: v flat, rolling, steep slope % of slope
JUL 2 9 1997
Soil Nature: sand, loam, clay, oche:/depth:
Ground water: at what depth? S s feet / Bedrock or Impervicus Material::`at-whai2depth7`= feet
Percolation test: / not required, required [rate min. per inch
Domestic water supply: /municipal, well, or er
If domestic water supply is a WELL, water supply from any sercic absorption is feet.
PROPOSED SYSTEM �L(-1 4-0..A Z e1.-� 3 Vj )3 e\\ O,n\ O.c\C\ d -mac
Septic tank: \ O b d gallon (minimum size: 1,000 gal.) _.ex
\�,
Tile field: each trench feet / Total system iecgth: feet
*?rovosec� ]Seepage pit(s): number of 2- / size each: IR ft. by 8 ft.
Size of stone to be used: # 3 / depth or tiiicic-ess feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each= gallons
CA1a'm 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 vvi.
I have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of
Queensbury Ranitary Sewage Disposal Ordinance.
Signature of responsible person: 4,4._„„,, ?''t Date: 2 frci
TO ^N OF QUEENSBURY
BUILDING t CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name r _t\\.,`1F(2 E E jt�
Location ( 1�j \r*) VD
Date gl iQ,\9 / Permit # 91-t 3
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Ra 'e-M'n to/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: To 1 Length
Length of each trenc -
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 Fiel Yesq t la
Openings Sealed? No Partial
LOCATIO1/SEPARATIONS:
Foundation to Tank may.-V;T, f et
Foundation to Absorption -L.E4 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
paddle Fro ,- Middle Rear
IRl�1 -
•
SYSTEM USE APPROVED: YES ciQ---:2)
Arrived: '. aI
Depart.. t
c
41
� /� // /
,iuiidin. 1pèctor
TOWN OF QUEENSBURY 2c)°
Yam - BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name (7\ .
Location T
Date F") VI/ Permit #91-'L-4 1j()
SOIL TYPE- Jane- oam-Clay-
Resul is of Pe cola d on Test-
(if app ''cabl :) Rare-Minute/Inch
TYPE OF S'
ABSORPTION FIE. D • Total Len•ti
Length of each - -
Depth of • -nches
Size of stone
SEEPAGE PITS: Number- 7
Size - ft. x ft.
Stone size j
PIPING: /!Size Type
Bldg. to Tank _ t
Tank to Dist. _ Box _ -
Dist. Box to Field/Pit lit
Openings Sealed? es o Partial
LOCATION/SEPARATION :
Foundation to Tank Vy,v.Meet
Foundation to Absorption
10 feet
Separation of Pits }"feet
Conforms as per Plot Plan es No
LOCATION OF SYSTEM ON PROPERTY`
(circle one)
Fro - Rear - Left Side - Right Side
'Odle Fronf-=—Piddle Rear
•
SYSTEM USE PROVED: S NO
Arrive .
Depar ed:
Building' I r
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name E iE CA. L'
Location (.'"W; V)iOP -)
Date )c—T Permit # 9-7
SOIL TY E: Sand-Loam-Clay-
Results of Perco ation lt-
(if applicable) R. e- /Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tora'l Length
Length of each trenc,
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:
Lr " OOP D -
'j C6 VV- �C `_` � -orb
7 \3 c \\c E
SYSTEM USE APPROVED: YES NO
Arrived:
Depart °`
vim-- G
v . wilding ns ector
1 have seen or observed,or believe 1 sow evidence of
all objects such as houses,wells,trees,fount Mc.,
shown on this document.I also represent that t have
personally mural tAe s oe the dram."
tom; d f(/9
gun, r DATE
RE\I‘ibly
PLOT P
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.
TOWN F QUEEV SBURy
BUILDINc
REVIEWED BY E_
OATS S CI
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