95-397 BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY 95397
TAX HAP NO. 44.-1-1.22 No.
WARREN COUNTY, NEW YORK
FULL MOON
PERMISSION is hereby granted to
1658 NACY RD.
OWNER of property located at 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 Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
NACY ROAD
QUEENSBURY. N.Y. 12804
2. CONTRACTOR or BUI LDER'S Name
STEVENSON, WALT
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
1 1 Wood Frame ( I Masonry ( )Steel ( )
7. PLANS and Specifications
SEPTIC)).ALTERATION TO INCLUDE: GREASE TRAP INSTALLATION AS PER
PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 35 PERMIT FEE PAID —THIS PERMIT EXPIRES July 12 19 97
(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 13 Day of July 19 95
(IA) ;
SIGNED BY for the Town of Queensbury
Building and Zoning ctor
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Application for . 1 RMII O
& €(LSe -tat p I n.3 ) r ) ,ro' S'I'AMI' RECEIVED
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Location of property r installation: /�� /<<� '` •1
n( e — (0Uwncr's Name I ( I
Owner's Mailing Address: 0 tP 1 1/(/(// 35-a -�
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Installer's Name: W�,�� �j IL�C� t�c.�f I'lionc #: ,�✓ G7� �J�_
JUL . 1995
Number of bedrooms (if residential):
TOWN OF QUEENSBURY ►-�
Total daily now (residential -compute (ii) 15(1 gal. per bedroom): BUILDING AND CODE I
Topography: flat 1 1 Rolling I 1 Steep Slope "i' of Slope
Soil Nature: 1 Sand I Loam I I Clay 1 1 Other /Depth:
:Oround Water: at what depth? _ feet
Bedrock or Impervious Material: at what depth? feel
Percolation'lest: (Xi Not Required I I quired/Rate min. per inch
Domestic Water Supply: I I Municipal 1K1 Wort I I Other
If domestic water supply is a WELL: water supply from any septic absorption is feet
PROPOSED SYSI I,M:
Septic tank: 4000 gal. (minimum size: I.t100 gal.) 6ce&rc //r aly
'File Field: each trench feet. / total system length feet.
Seepage I'it(s): number of / size each: ft. x It.
Size of stout to he used: tY / depth or thickness feet.
HOLDING 'TANK SYSI FM: (if required)
Number of tanks: Size. of each: gal.
IL Alarm system and associated electrical work to be inspected by a certified agency.
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
r behalf of an applicant, shall be void.
1 have read the regulations with respect to this application and agree to abide by these and all
requirements o f the Town o f Queensbury Sr ttitary ,Sewn fe Disposal Ordinance.
� � 7/' '
Signature of re,rponsib'e pc r,con: / �( /,� Urr1e: �J
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TOWN OF QUEENSBURY 10/9,92
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
CI r -f2
Name c0\\ cc\odi-
Location \. f '"\o c‘r
Date g"Ic "c_s Permit # q5 3 d1 7
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) R e- •nute/Inch
TYPE OF YSTEM: (01(:/1.-
ABSORPTIs FIELD: Tot 1 Length
Length of - .di trenc
Depth of tr:nches
Size of ston:
SEEPAGE PITS: Numb •r-
Size - , t. x ft.
Stone size
PIPING: Si Type
Bldg. to Tank 3e
Tank to Dist. Bo
Dist. Box to Fie d/Pi
Openings Sealed? Ye No Partial
LOCATION/SEPARA IONS:
Foundation to T nk feet
Foundation to Aisorption feet
Separation of P is feet
Conforms as per Plot Plan Yes No
LOCATION OF SYS M ON PROPER :
(circle -
Front - - L- t Side - Rig,t Side
Middle . t - Mi i d1 a Rear
COMMENTS:
e3.1A) --r-Alz 41) - 1,A) �SYSTEM USE APPROVED: 1111 NO
Arrived: /0:/0
Dep ted: /0: 2 0
Building Inspector
Grose Tt( i.D j-tety-fa i/Cefrit.,
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