98-760 BUILDING PERMIT
VALUE $ @ TOWN OF QUEENSBURY No
98760
TAX MAP NO. 27. -2-8 WARREN COUNTY,NEW YORK
PERMISSION is hereby granted to BELEVICH-14 SON, I0.ART.k J
OWNER of property located at 1660 RIDGE RD. Street.Road or Ave.
in the Town of Oueensbury,To Construct or place a SEPTIC- AT.TRP ATION
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. OWNER'S Address is
1660 RIDGE RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
COOKS SEPTIC
3. CONTRACTOR or BUILDERS Address
12801
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by XI SEPTIC
1 1 Wood Frame I I Masonry ( I Steel 1 I
7. PLANS and Specifications
SEPNIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$. Proposed Use
SEPTIC ALTERATION
25 December 1119 2000
$ PERMIT FEE PAID -THIS PERMIT EXPIRES
(If 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.l
11 December 1998
Dated at the Town of Queen ry this Day of 19
SIGNED BY for the Town of Oueensbury
Building a Zo I Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of QueensburyCommunity CA 7 t/ 0
Dept. of Development Permit No.
Building &Codes Office
742 Bay Road Fee Paid a_'_, `oo-)D
Queensbury, NY 12804
Locadon of property for installation: I> 57- au Q e•-)S 6 1)
Property Owner's Name: 1)ltT/a Be / V) (-
Property Owner's Mailing Add ie C° el YL ai-e e , 5 4 u�
Installers Name: zf,,,,4'.5-- p 7-, L Phone # 6/'p �00
Number of bedrooms (if residential): 3
Total daily flow: S
(residential - compute @ 150 gal./bdrrri.), 1998
Topography: xflat, roiling r I
slope �/, ! ' % of slope
Soil Nature: X sand, - V loam, clay, other /depth:
&le k e -
Ground water: at what depth?410104.feet / Bedrock or Impervious Material: at what depth? — feet
Percolation test: not required, recuire [rate min. per inch
Domestic water supply: municipal, well, other
If domestic water supply is a WFT-T, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank:/?10 gallon (minimum size- 1 000 gal.)
;,icr.irAl-orS
000
Tile field: each trench 0 feet / Total system length: / — feet
Seepage pit(s): number of / size each: - ft. by ft.
Size of stone to be used: # I depth or thickness feet
•
_OLDENG TANK SYSTEM: (if required)
Number of tanks: - Size of each: gallons
(
Alann system and associated electrical irk to be inspects3 by a certified agenry.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Qneensbury, any permit or
apv,vz dl2-rated which is based upon or is granted is reliance 1.. --sa any raterial misrepresentation or failure to make a
material fact or circumstance known by or on behRlf of an applicant, shall be void.
I have �d the regulations with respect to this application and agzee to abide by these and all requirements of the Town of
Queers-.:y Sanitary Sewage Disposal Ordinance.
Signature of responsible person: �t-li Date: /Z"14-9/
4, • 4 31a)()r)
TOM OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name (v F, le
yCZO
Location Wi2W (v 3,)" ' '—_1
Date/—Al Penn t #P r "-7 6, 0
SOIL TYPE'4 ' a -
Results of Percol .tion T st-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: 1
ABSORPTION FIELD: ' otal Length \�
Length of each tre h <1262,01
Depth of trenches k'-rDz,
Size of stone tF‘,tt -1,
SEEPAGE PITS: Numbe
Size - ft. x ft.
Stone size
PIPING: i Size Type
Bldg. to Tank IL i��
Tank to Dist. Box 4"" h9e_ 4-
Dist. Box to Field/Pi, 4% -c N AL:
Openings Sealed? `es o Partial
LOCATION/SEPARATION'.
Foundation to Tank a.,0-,_ feet
Foundation to Abso •tion 011, eet
Separation of Pit _'-et
Conforms as per P of Plan ` ,/ 0
LOCATION OF SYST ON PROPER" .
(circle one)
Front - Rear - eft Si_de - Right ' ide
Middle Front - iddl a Rear -
COMMENTS: _--.--ry..— .
SYSTEM USE APPROVED: ES NO
Arrived: , O
Depart- , ' '7 / .-
j A/I 41I
,-Bui 'ding I 's►ector
f
a
v
I have seen or tbserved,or believe I saw evidence of,
all objects such as houses,wells,trees,fences, etc.,
shown on this document I also represent that I have personally measured the distances set forth on the diagram:' 1 g 7 7(/�
3 .
4vi 1)--9-95,
__ SIGNATURE DATE
rf^O() •
TOWN OF QUEENS=URY
BUILDING & 12'" - 1 ''PT. TOWN ofa ENSBURYBUILDINGDEPARTMENT
Based on our kited examination,
REVIEWED BY f ( / compliance with our shall
not be construed as indicating the
DATE /Z / - plans and specifications are in full
compliance with the code.
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