97-487 - BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 97487
TAX MAP NO. 37 . —4-1 . 8 WARREN COUNTY, NEW YORK
21j 4/aol
PERMISSION is hereby granted BRYANT. RONALD & _At\T(ZFI,.A
OWNER of property located at 9 NORTHWOOD DR - Street. Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTTr ALTE-RAT-1-(IN
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. OWNERS Address is
HAWTHORNE RD.
LAKE GEORGE , NY 12845
2. CONTRACTOR or BUILDERS Name
CONDON'S SEPTIC & DRAIN
3. CONTRACTOR or BUILDERS Address
0
4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( I Masonry ( )Steel (
7. PLANS and Specifications
SEPT]! . ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES August 26 19 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 26 Day of August 19 97
SIGNED BY _ ±L.- , for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Perm•it No. "'(g
7
Dept. of Community Development
Building &Codes Office U 0
742 Bay Road Fee Paid $d
Queensbury, NY 12804
Location of property for installation: ? 1 1 w mocAni e
Property Owner's Name:Ro f/,/3) Qg/4tiJ n U G 2 6 1997
Property Owner's Mailing Address: 71YAI/iiitt0g./j/E (PP
Installer's Name: Phone # • 7f��
Number of bedrooms (if residential): Total daily flow: Y5-6)
(residential - compute @ 150 gal./bdrm.)
Topography: )c flat, rolling, steep slope 50 of slope
Soil Nature: k sand, loam, clay, other/depth:
Ground water: at what depth? y4 feet / Bedrock or Imperv_cus Material: at what depths eet
f�
Percolation test: I< not required, required [rate min. per inch
Domestic water supply: . )( municipal, well, c.±er
If domestic water supply is a WELL, water supply from any senc absorption is feet.
PROPOSED SYSTEM
Fyct.C-41
Septic tank:jdOo' gallon (minimum size: 1,000 pl.)
Tile field: each trench feet / Total system! igth: feet
Seepage pit(s): number of *2-- / size each: (' - ft. by g- ft.
•
Size of stone to be used: # - / depth or thickness 2 feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
`Alarm system and associated electrical work to be inspected by:certified agency.
For your protection, please note that pursuant to Section 136-29 of the Code of 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
I have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of
Queensbury S,+t,itary Sewage Disposal Ordinance.
Signature of responsible person: t g Date: / ' �.5�—!
- TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT? I
742 Bay Road �/�
Queensbury NY 12804 l V
(518) 761-8256 1(+, n
SEPTIC DISPOSAL SYSTEM INSPECTION 'IJV1ibJ
Name
Location _, a ...;1 II& ! lib r
Date Permit '• — 1
r�-
SOIL TYPE: •ar�d Loam-Clay-
Results of Per olation Testi
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIEL : Total Le gth -
Length of each t ench
Depth of trenches
Size of stone A
SEEPAGE PATS: Number- it
Size - ft. x IF ft.
Stone size _
PIPING: , Size Type
Bldg. to Tank ` A. S fitJ6
Tank to Dist. Box L' 1 'w-yO 9-0
Dist. Box to /P ' 01 a ''
Openings Sealed? Ye) No Partial
LOCATION/SEPARATION .
Foundation to Tank .___" feet
Foundation to Absorpti •n feet
Separation of Pits feet
Conforms as per Plot 'l an s No
LOCH, ON OF SYSTEM ON PROP
1 -gone)
Fro Rear - Left Si.e - R .ht Side
ddle Front - Middle .'ear
COMMENTS:
•
SYSTEM USE APPROVED: YES NO
Arrived: /D: 6
Departed: / /
ViaV
Building Inspector
l<0&Alp lstx! #M'V ( 0revD(,,V 5 -, (.%o-e.(C,�-yv"whit rl% cs
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trie530 i 11- oy Gens' F fJ. "rr-
I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells,trees,fences,etc„
shown on this document. l also represent that I have ' n — ��S /
personally measured the distances set forth at the
Ifi$g110
SIGNATURE DATE , " AUG 23 l997
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It ti ge REVIEWED BY r/ , i
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