98-725 BUILDING PERMIT
TOWN OF QUEENSBURY
VALUE $ 0 No. 98725
TAX MAP NO. 13. —1-21 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to LEWIN, LORRAINE
OWNER of property located at 37 MASON RD. 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. OWNERS Address is
P.O. BOX 263
CLEVERDALE, NY--.---12820
2. CONTRACTOR or BUILDERS Name
3. CONTRACTOR or BUILDERS Address
4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( ) Masonry ( )Steel I )
7. PLANS and Specifications
SEPTft ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 2000
PERMIT FEE PAID —THIS PERMIT EXPIRES November 19 19
(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 Quee sbury this 19 Day of November t9 1998
SIGNED BY for the Town of Queensbury
Building and oning Inspector •
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept. of Community Development Permit No.92
Building & Codes Office
742 Bay Road Fee Paid $ LJ
Queensbury, NY 12804
Location of property for installation: / ` '/
Property Owner's Name: L , ea/ �T
Property Owner's Mailing Address: �d Arc 2-6) aektfAvg2.-
UO,�! 1998
Installer's Name: �' — Phone #
•
. Number of bedrooms (if residential): if Total daily flow: (oO t
(residential - compute @ 150 gal./bdrm.)
Topography: flat, V' rollin„ steep slope % of slope
Soil Nature: sand, v loam, clay, other /depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: not required, required [rate min. per inch]
Domestic water supply: municipal, well, other /4'ka
If domestic water supply is a W`FT.T, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank:/C6Lc) gallon (minimum size: 1,000 gal.)
Tile field: each trench 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
,‘(mP `-//C $? P g /ri/6 •
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
Alarm system arirl 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 misrepreserntion or failure to make a
material fact or circumstance known by or on behalf of an applicant, shall be void.
I have read the regulations with respect to this a -c 'on and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal •
Sib ature of responsible person: ‘��`1 3 r®� Date: )1 ` 4 Y •
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DATE