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1987-804
w Sr r 6 } • 1 CERTIFICA M OF OCCUPANCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date September 15 19 $ 87-804 f This is to certify that work requested to be done as shown by Permit No. i has been completed.. i i This structure may be occupied as a / of a two family dwelling Y ovation 54 Queen Anne Court, Queen Victoria's Grant, Model C i Comer Guyer Builders. Inc. i 1 By Order Town Board TMWN OF QUEENSBURY Building & Zoning Inspector a 1 I BUILDING PERMIT yHy r TOWN OF QUEENSBURY No. 87-804 � . WARREN COUNTY, NEW YQRK � PERMISSION is hereby granted to Queen Victoria ' s Grant r r,s OWNER of property located at 54 Queen Anne Court Street, Road or Ave. in the Town of Queensbury, To Construct or place a of Two Family Dwelling 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 . OWNE R'S Address is Guyer Builders 10 119 Bunning St . ro_ Ballston Stpa , N . Y . 12020 c 2. CONTRACTOR or BUILDER'S Name � R O Same F' Po 3. CONTRACTOR or BUILDER 'S Address rn r rt Same l n 4_ ARCHITECTS Name 5. ARCHITECTS Address XD C m fb 6. TYPE of Construction — (Please indicate by X) y, ( Wood Frame ( ) Masonry ( I Steel I I ro b 7. PLANS and Specifications rt rt No 30 ' x 30 ' as per plot plan , specifications and application including septic system and attached one car garage . MODEL C S. Proposed Use } of Two Family Dwelling a $ 5 . 00 C/O $ 75 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES June 1 , 19 88 0 (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 30ttt Day of November 19 87 m SIGNED BY ,�,-'�r— for the Town of Queensbury Building and Zoning Inspector /L.+'�--- oq Application Noe k r, Jvt�I G► ItQer�satsry Permit Issued lg t, BUILDING and ZONING DEPARTMENT Permit Expires 19 ' OCT 24 198 Bay and Haviland Road, R.D. 1 Box 88 Zoning Designation Queensbury, New York 12801 variance No. C. Site Plan Ravi Approved b : ,I' 700 d APPLICATION FOR cle BUILDING AND ZONING PERMIT ' a w • e • +Ir it i+ i+ ++ w e * ++ +a ++ i► at a it +r it ++ +t i+ r► i+ M w +F * i+ ++ i+ ++ ++ it • e :re A PERMIT MUST Be OBTAINED BEFORE BEGINNING CONSTRUCTION . ANSWER ALL OF THE FOLLOWING . The undersigned hereby applies for a Building Permit to do the following work which will be done in accordance with the description, plans and specifications submitted, and such special conditions as may be indicated on the Permit . The owner of this property is : Gu er Builders Inc . P . O. Address 119 DLmning Street Ballston Spa , New York 12020 Tel . ( 518 ) 899-9161 Property Location : 54 g1leen Anne Court Tax Map No ,121 / 4 ,/ 2 Street number or building lot number Subdivision name (if applicable) 'queen Victoria ' s Grant THE PERSON RESPONSIBLE FORSUPERVISION OF WORK AS REGARDS BUIL DING CODES IS : Richard He { er III ( 518) 899-9161 eleeyjsome � P. O. Address Tel . Noe Name of builder Guyer Builders , Inc -Address 119 Dunning Street Tel ( 518) 899-9161 Name of plumber Guyer rs , c •Address MWMrg Stree Tel . - Name of mason yer rs , nC .Address g ree Tel . NATURE OF PROPOSED WORK : * ZONING INFORMATION : X Construction of a new building * A PLOT PLAN MUST HE PREPARED AND SUBMITTED , Addition to a building * drawn reasonably to scale and attached hereto , Alteration to a building * showing clearly and distinctly all buildings , (no change to exterior dimensions) * whether existing or proposed and indicate all other work (describe) set-back dimensions from property lines . Give * street and number or lot number and indicate " whether interior or corner lot . Show location FOR 'DEMOLITION PERMIT , STATE SIZE AND * of water supply and location and configuration LOCATION OF STRUCTURES AFFECTED. * of septic disposal area . * COMPLETE INFORMATION REQUIShanREDpE�OW - Size of property 100± P ft X 120 ft . * Existing building ( s) Size ft X�'-ft . PROPOSED BUILDING AND USE : of � * Existing building (S) Use NIA Size of new striLan u e 3aQ ,_ft X�ft # Foundation-pier slab crawl/partial/full Proposed buildings seesp otepfrom property Line circle one} 2 * Front yard 30+ ft Rear yard 30+ ft - No . of stories (habitable space) * Side yards+ ft and 15+ ft Height (grade to ridge ) 22 ' - 6" ft • * If on corner : setback from side street ft If residential* noo of families I f 2 Noe of rooms (excluding baths ) � * OCCUPANCY INFORMATION Noe of bedrooms * PRIMARY BUILDING - No. of bathrooms 2 one family dwelling g �T ""a t e or primary heating system a ar a ectric* -Two family dwelling 8 * ,Type of fuel Electricity * Multiple dwelling / Number of units Noe of fireplaces to be installed * Permanent occupancy will a wood stove be installed? Na * Transient occupancy Central Air conditioning? No Business * BUILDING STYLE, PRIMARY STRUCTURE Industrial Other Ranch Contemporary Lo cabin * If additione what will use be? Raised ranch Mansion Du le rt Split level Old style Bungalow Cape Cod Cottage Other ACCESSORY BUZLDZNG- 11 car/ car Colonial Row Town House * Detached garage/one car/ two ( CIRCLE ONE PLEASE ) * _Attached garage/one car/ two Car/ one Car * * * * f * • * r * w k * * * * * Private storage building 1 . ESTIMATED MARKET VALUE OF " Other CONSTRUCTIONend INFORMATION ON - BUILDING SPECIFICATIONS . ON REVERSE SIDE OF THIS SHEET . TO BE COMPLETEDI Form BPA 4/86 md-vl BUILDING PERMIT APPLICATION CONTINUED - BUILDING SPECIFICATIONS : Type of construction , wood frame, fire safe etc , wood frame Will any second-hand or ungraded lumber be used? if so, for what? no Foundation wall material concrete black Thickness 819 Depth of foundation below grade (to bottom of footing] " minimum Will there be a cellar? -no Heated or unheated? Floor sq. footage sq ft Will there be a basement? no Will any portion be used as living space? ( If so, what por - ? _sq. ft . - - Type of use? Type of roof - sloped . lot/shed/other Material of roof Fiberglass rs ass s ' es Size , wood studs "X 6 " spacing 24 "o . c . length 8 ft . tex Q Joists ( floor beams ) lst . floor N/A " r walls x spacing "o . c , spanN�A ft , +joists ( floor beams) 2nd . floor �2 llx�-11 spacings. Igo . c . span'=ft . Overlays (ceiling beams ) 2 "X spacing 24 "o . c . span 14 ft , Roof rafters 2 "x 10 spacing 4 o . c . span 4 ft . Roof trusses (pre-engineered) spacing 2 "o . c . span N/A ft . Exterior wall finish stained of what material? 5/8" x 4 ' x 8 ' texture 111 Interior wall finish pain sfieetrock If a garage is to be attached , describe materials to be used for FIRE SEPARATION : 1 /2" type 'IXrr sheetrock Is there to be an opening between garage -find dwelling? YeS If so will a Fire-rated door , enclosure , and self-closing device be provided? yes Will a flue-lined chimney be installed? No Height above roof. N/A_ ft _ Depth of chimney foundation below grade N A ft . Depth of fireplace hearth N A ft . in , Water supply - Municipal or private well aauliclpal SEPTIC SYSTEM _ Distance from ANY private well ( i.ncluding adjoining properties ft , (A separate application is necessary . for an re air or new installation of septic system) See S . P. E, ll. S . permit # 026252� Town of A F F i D A V I T STATE OF NEW YORK ry Warren County off Warren I smear that to the best of my knowledge and belief the statements contained in this application , together with the plans and specifications submitted, are a true and complete statement of all proposed work to be done •on the described premises and that all provisions of the BUILDING CODE , THE ZONING ORDINANCE , and all other laws pertaining to the proposed work shall be complied with, whether sp ified or not , and that such work is authorized by the owner . SWORN TO BEFORE ME THIS Signature ,y'J� "/ , er, owner ' agent , ar� erect , contractor f day o f CS' xG�tir 19 S PATRICIA E . FURPHY Notary Public. State of New York Notary Public , Warr�4t Qua]ifierl rn Sr1 crr:.ct. dv County N . Y . 47 , 7048 * • t * r w .t w * , * ,� * * * y, * * %Co nmiss*n *xperea S*ptr3Gk lit. sr" * ,r �r * * s ,r * yr * * • w s r R SPEC) 4i, CONDITIONS OF THE PERMIT : Ll 975 Square feet living 264 Square foot garage - one Stall 1239 @ $7 . p(}/100"or pact of 5 ' One Stall garage C/O permit Total TOWN OF QUEENSBURY locos WARREN COUNTY $ NEW YORK 1lpplication for : BUILDING PERMIT IN COMPLIANCE WITH THE NEW YORK STATE ENERGY CONSERVATION COPSE A permit must be obtained before beginning work . ANSWER ALL of the following : 1 . Gross floor area 975 S . F . 20 Type of heat Baseboard electric 3 . Is the building mechanically cooled ? No 4 . Percentage of area of windows and doors A . Over 16 % Only 1 . Uo value of gross area of walls , roof/ ceiling and floors exposed to ambient conditions 2 . Floor over heated spaces YES NO a . Are foundation walls insulated ? YES NO 1 . If YES , what is the R value ? 3 . Slab on grade YES N.Q a . If YES , what is the R value of insulation around perimeter of floor ? 4 . Is basement heated ? YES NO a . R value of insulation 5 . Type of insulation B . Under 16 % Only 1 . R value of roof and floors exposed to ambient conditions. R-38 2 . R value of exterior walls KNMX R . 23 . 5 U. ZP004 3 . R value of glazed area U=O1 30 4 . R value of doors R-14 . 9 (U* =0 . 60) 5 . R value of floors over unheated *paces ur-14 6 . R value of slab edge insulation - unheated slab N/A 7 . R value of slab insulation - heated slab 12 . 5 8 . R value of heated basement/ cellar walls ( above grade ) N/A 90 R value of heated basement /cellar walls ( below grade ) N/A 106 Type of insulation Fiberglass C . Controls 1 . Thermostat maximum heat setting D . Duct Systems N/A 1 . Is duct system installed in unheated spaces ? YES No a . If YES , R value of duct installation b . I. R value of duct in other areas E . Piping Insulation N/A 1 . Size of hot water or cooling carrying agent pipe 2 . R value of pipe insulation F . Service Water Heating 1 . Performance efficiency N/A 2 . Temperature control setting maximum G . For Swimming Pool Only 1. Maximum heating N/A m Telephone Noss ( 518) 899-9161 { applicant ' s njvft re ) 11AW APPLICATION FOR SEPTIC DISPOSAL PERMIT Ref : S . P . E . D. S . DATE September 29 87 permit # New York - 0202525 MODEL C of C/K LOCATION OF PROPERTY FOR INSTALLA17ON 54 Queen Anne Court Owner's Name: Guyer Builders , Inc . Telephone: ( 518) 899-9161 Address: 119 Thinning Street , Ballston Spa , New York 12020 Installer's Name: Guyer Builders , Inc Telephone: ( 518) 899-9161 2 A, C , E, I , J , K, L, M ,Number of bedrooms (residential only) 2 _ 3 F , G, H r Total daily flow (compute Q 150 gal per bedroom) 300 M Topography: circle one: Flat Rolling Steep Slope % of slope Soil Nature: circle one: Sand Loam Clay Other / Depth: 8 ' feet + Ground Water: At what depth? tu"4101 8 feet + Bedrock or Impervious Material: At what depth? unknown feet Parcolation test:. circle one: not require required / rate min. inch. Domestic water supplyze circle one: Municipal Well Other IF domestic water supply is a 'well: Sep:nratioe: Watersupply from Septic absorption NIA feet * PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1,000 gal.) TILE FIELD: Each Trench N/A feet / Total system length N/A feet * SEEPAGE PIT(S) : Number of / Size each feet by feet * Size of stone to be used # I Depth or Thickness feet s * ss * s t * ale * * * * s * ss * i * * * * * * s * * ► i * * * * * * # s * asaG IMPORTANT * See S . P. E . D . S . ...Pleasee.eLIST NEW EQDIPMUNT TO BE INSTALLED permit & attached * * * * * s v * * * * e s * * * * e * * * e e * * * * * * * * s * * s * * * * sc * map . (over) Section II Septic System Inspections: A. All applications for septic system installation, alteration or repair, as required by the Town of Queensbury Sanitary Sewage Ordinance, shall be submitted to the Building Department at least 24 hours before start of construction and shall include a plot plan showings 1.) the proposed .location of the gystem 2.) location and distance to lot lines 3.) location and distance to structures 4.) location and distance to any water supply 5.) size and dimensions of all tanks, distribution boxes, tile fields and/or drywells Be No system shall be covered before inspection and approval by the building Inspector. Failure to comply with this requirement may result in the uncovering of the system by the installer and a fine of up to $Z50.00. Co An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installation, alteration or repair of an approved system, a new proposal must be submitted to the Queensbury Building Department before further construction. I have read the regulations above and agree to abide by these and ail requirements of the Torun of Queensbury Sanitary Sewage Disposal Ordinance. Signature of.responsible person. Date: Town of Queensbury Building and Code Department Bay at Haviland Road Queensbury, New York 12801 (518) 792-5832 SETTLED 1763 . . . Hf'MF OF NATURAL BEAUTY . . . A GOOD. PLACE TO LIVE TOWN OF QUEENS'BURY BUILDING AND CODES DEPARTMENT BAY & HAVSLAND ROADS QUEENSBURY, NEW YORK I280k TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION 15'de if ir q �'} DATE PERMIT /~ APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATIXON/DAMP—PROOF.T NG BACKFILL APPROVAL ,ROUGH PLUMBING FRAMING ,ELECTRICAL ROUGH-XN INSULATION: T FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT l ROOFING SIDING EXTERNAL PORCHES STEPS STAIRS—CLEARANC & RAILS PLUMBING FIX TU SfRELIEF VALVE INTERIOR TRIM/ RIVACY DOORS FINISHED FLOG S — GARAGE FIRE P PING DOOR CLOSER ( } SMOKE DETEC RS FINAL ELECTRI AL INSPECTION FINAL APPROV L OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED!' REMARKS: _Z1 I PEC TOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT ,,ryry BAY & HAVILAND ROADS / P �. QUEENSBURY, NEW YORK 1280!& f�'j TELEPHONE (518) 792--5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR INSPECTION RECEIVED NAME �r eo LOCATION DATE PERMIT # ti � I APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP—PROOFING BACKFXLL APPROVAL ROUGH PLUMBING FRAMING ELECTRICAL ROUGH—IN ! �ULATION: OUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING OL EXTERNAL PORCHES/ E�S — STAIRS—CLEARANCE RA LS PLUMBING FIXTURE /RELZ VALVE INTERIOR TRIM/P IVACY ORS FINISHED FLOOR GARAGE FIREPR FING DOOR CLOSER (S) SMOKE DETECTO S FINAL ELECTRIC L INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERT FICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISE ARE OCCUPIED! 5 REMARKS: IN ECTOR TOW RY BUIL OF QD CODES DE BUILDING AND CODE5' DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 128046 TELEPHONE (5I8) 792-5832 BUILDING INSPECTOR ' S REPORT c_ REQUEST FOR INSPECTION RECEIVED NAME _ �y LOCATION yj ',0- DATE �/ 6�~ S�7 PERMIT # e2i-7 ` 'SbQ .APPROVED YES NO FOOTING/PIERS MONOLITHIC P R FORMS FOUNDATION/D -PROOFING BACKFILL APPROV L 'A 60OUGH PLUMBING C FRAMING ELECTRICAL ROUGH-I INSULATION: FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: 3 CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/ TEPS STAIRS-CLEARANCE & RAILS . PLUMBING FIXTUR S/RELIEF VAL/� INTERIOR TRIM/ RIVACY DOORS FINISHED FLOO GARAGE FIREPR FING DOOR CLosSR (S SMOKE DETECT RS FINAL ELECTRIC L INSPECTION FINAL APPROVA OF CONSTRUCTION A SIGNED CER FICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS: I SPECTOR TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS y y� QUEENSBURY, NEW YORK 12801- I ] TELEPHONE (518) 792-5832 BUILDING INSPECTOR ' S REPORT REQUEST FOR .INSPECTION RECEIVED NAME r / IOU.I OCATSO9N` /, .r+ j f DATE /j7L G PERNITTf APPROVED YES NO FOOTING/PIERS MONOLITHIC POUR FORMS J..wTOUNDATION/DAMP-PROOFING V]gACKFSLL APPROVAL . all INZA I ROUGH PLUMBING FRAMING ELECTRICAL ROUGH-IN INSULATION: FOUNDATION FLOORS WALES CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/S!r-EPS STAIRS-CLEARANCE ,F RAILS PLUMBING FIXTUR /RELIEF VALVE .I _ NTERIOR TRIM/ VACY DOORS FINISHED FLOOF � GARAGE FIREP FING DOOR CLOSER ) SMOKE DETE ORS FINAL ELECTR CAL INSPECTION FINAL APPRO L OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED! REMARKS : INSPECTOR TOWN OF QUEENSBURY BUILD-TNG AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12804- TELEPHONE (518) 792-5832 BUILDING INSPECTOR' S REPORT �r REQUEST FOR INSPECTION RECEIVED!!: I3 NAME L OCATION DATE PERMIT # - d APPROVED YES I NO FOOTING/PIERS MONOLITHIC POUR FORMS FOUNDATION/DAMP--PROOFING BACKFILL APPROVAL J .oROUGH PLUMBING FRAMING r ELECTRICAL ROUGH-IN +r INSULATION: / FOUNDATION FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING ,EXTERNAL PORCHES/ EPS STAIRS-CLEARANCE RAILS PLUMBING FIXTUR /RELIEF VA VE INTERIOR TRIM/F' IVACY DOORS FINISHED FLOOR GARAGE FIREPR FING DOOR CLOSER ( ) SMOKE DETEC RS FINAL ELECTRI AL INSPECTION FINAL APPROV OF CONSTRUCTION i A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIEDI REMARKS: - INSPECTOR NON . Jown otseens �ur� ¢„ BUILDING and ZONING DEPARTMENT -+� Bay and Haviland Road, R. D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION LOCAT I ON S e .0 ra 44 DATE I ! PERMIT NO , ( SOIL TYPE - and. am .aa $- Clay Percolation Test Required? YES - NO Percolation ratty - Min/Inch TYPE o SYSTEM: ��..- Length ch trench Absorp zon f ie al lex t L>e of trenche Size of g _ SEEPAGE PI 4mumber of) Size- `�ft . X -�ft. Gravel size PIPING : Size Type Bldg . to tank " �' y C-- Tank to list. bo (3v C - Dist. box to fief flit �pycm � - - Cpening's sealed? ES NO Partial LOCATION/SEPARATI Foundation to tax ft. Foundation to orpt n ft Absorption to t line ft Separation of its ft. LOCATION S STEM ON PRbPERTY ( rcle one) Front - ea - Left side- Right side - +CnM►KENT . 1 1 i SYSTEM USE APPROVED Y NO 112 Building Inspeo or 01/86 and vl r } f�/ � ,��ocerer ©� �ttYen 3 hurs� BUILDING and ZONING OFPARTNIENT r Bay and Haviland Road, R .O. 1 Box 98 Queensbury, New York 12801 BU1LD [ NG INSPECTOR ' S REPORT NAME LOCATION {t✓ ; .L/ ' G� tt�+ C.1 ,/ Date / ' / Q � Permit No . '! ~ Ly w w * w w w w w w w w w w w w w w w w w w w w ✓ APPROVED - YES NO I'ootinc3/Pier Farms X Foundation Waterproofing �3ackfi 11 vramipg Roofing .iir3ing Masonry Veneer Rough Plumbing Relief Valves Ext . Porches P-Iniahed floors Interior 'Prim .stairs & Railing. j Cellar Drain 'I`i Concrete Floor Plbg . Fixtur Czar . Firepr fin g Door Close k,;Moke Det tors j chimney L,.Y}TS U I.AT I N oun (Aa nIX Floors i Walls_ Ceiling FINAL I-A EC RICAL INSPEC"PION ' 1)RIVEWAY APPROVAL Final Building Survey Next wcheduled inspection ( call when ready ) Remarks- CJ2& rr"r'.1-&A/_."L..`I_;7.+.1 To Iiuildan9 Inspe to C>ff3C, ma-VI + } BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.0, 1 Box 98 Queensbury, New York 12801 BUILDING INSPECTOR ' S REPORT NAME LOCATION Date Permit No . [ F < ~ ✓ = APPROVED �..-Z�oting/Pier Forms Foundation Waterpro Ping Backf111 Aepolo Framing Roofing Siding Masonry Ve eer Rough Plum ' ng Relief Valy s l.xt . Porches Finished Flop S Interior Trim Stairs & Railin s Cellar Drain Til Concrete Floors Plbg . Fixtures Gar . Fireproof in Door. Closers Smoke Detector Chimney I N S U I.AT I ON : Foundation Floors walls Ceiling_ FINAL ELECT ICAL INSPECTION DRIVEWAY APP OVAL Final Building Survey Next scheduled inspection ( call when ready ) Remarks- Building spector G/86 and-vi . Jaurr� o/ Quee" i " ry BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R. D. 1 Sox 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME Ul LOCATION ] DATE / c? /7 PERMIT NO. � SOIL, TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/inch TYPE of SYSTEM : Absorption field , total length .' Length of eac trench Depth of tren es Size of gravel SEEPAGE PITS#Ntnkber of ) Size- ft. X �ft. Gravel size PIPING : Size Type Bldgw to tank Tank to dist . box � . Dist . box to field/ W Openings sealed? S NO Partial LOCATION/SEPARATIONS, Foundation to . •tank `it ft. Foundation to absorpti n ft. Absorption io lot line ft . SeparatiorV of pits ft . LOCATION SYSTEM CST PR k�PERTY (circle one:) Front ear - Left side Right side - CCmMENT SYSTEM USE APPROVED YES NO Building InA&ctor 01/86 and vl awn o/ �+ueens �urc� BUILDING and ZONING DEPARTMENT Bay and Maviland Road, R. D. 1 Sox 98 (Oueensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCATION/ DATE l PERMIT NO. SOIL TYPE - Sand - Loam - Clay Percolation Test Required? YES. - NO Percolation rate - Min/Inch _ TYPE of SYST>rM: Absorption fiftld , total lelagth Length of each trench Depth of trenches -"— Size of gravel_ � ! y` SEEPAGE PITS{Numh_ er a£ -- Size- �ft. X ftY. Gravel size PIPTNG : Size Type Sgm to tank A " , Tank to diet . box Dist. box to flelc)r/pit Openings sealed? jrr, YES NO Partial l LOCATION/SEPARArrXONSO Foundation to k ft Foundation to sorptio ft _ Absorption to of line Separation of pits €t LOCATION OF S STEM ON ircle one ) Front - Rear Left ide - Right : side - CCMMEMTS : r SYSTEM USE APPROVED yE O B 1 ing Inspector 01/86 and vl REFEPENCE DRAWINGS CLEANOUT TO GRADE e-0 DIAMETER 9'-0 DEPTH QUEEN VICTORIA' S GRANT QUEENSBURY , NY. 5A SITE UTILITIES SEPTIC t WATER * FIELD CHECK DIMENSION QUEESSC NANNEOURT PLOT PLAN 4 SEPTIC SYSTEM GUYER BUILDERS, INC. QV- 27 DWN : Scale ; I"= 2v- 0