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SEP-0700-2021
............... ...................... ... ........ ... .. ... .............. ............... Office lice nly ............ Pertnit#: 0 I-01D.......... ................ ry. SEP Permit F M6 et* A2- 05 .... .. Invoict:.-O. ............ jq OF C�UE :N 0606 wed::B' Flood Zone? S - IS D ERMITAPPLICATION EPTIC:DIS � nwe Peblect Lo'cAlohi.i. Ta* x Map:9: -: w . RESIDENCE.INFORMATI OW r_v ear,8.0t: Gallons 4 of Bedrooms: "galions per total dailyA:w o : p ay. bedroom d d Gq�b -G d Yes, N per. _age-: rin er :1980. det 150 .. .... 10 ... ... ...... ....... ... . ....... -198*149�i: .130( r.H t'.T"b... Nes . ..... . Hot 'Tub............... ........; n.s.ml gl ft 1'P1.*d?*--,(circ1e one) 4992-Pre...s4n-f -110 FlPARMINFORMAT .... ... .................... T j 'SteepSloe g Sl Wo .6*6,0,hy Flat Rolling: -� ... ..... . .......... .. ... cl :5011.N*a:tuM Loam ay Other; explain.,: F :1,GroU:hd'w er . ..... At .. ...... what clepth�: imperious material At 'Kai depth .......... . ....... .06Mestic Water:S PP:1y uniciPa. M H ._,`..:lake if Well or lake water supply.-fr om an..ysepk-systemabsorption is ..... . ..... Pe.rco1atioh:Test Rate: p.e.r:m.1 wte p'evi chtest;-to:be>. ' va ....... ......,!licensed gnk1qe'&/ e.01tect): .... ...... .PROPOSEUSYSTEM-INFORMATION. ...... ........ ..... ...... . ..... .94 ank allonsfmin. Size 1 ..Cl -.:-250:g4jl*6hsf6r:eac*h: 10.0gallons,add ' c 1�q spa :Zy 'slin: tu b ... . . . . .......... :j S terh-�� -AbsbrOtiorifiold w/#?stone Total I'f fit:; Trench _20 Seepage gq:Pit .w/#3:St0e Novo man AftetbaUJve:Sy_tem Bed h or ot ertype: -SYS ?� H*-6 dp i T6` k'System Total required capacity an size g h. tanks: ............................ .......... .. .... ... ........ ........... ..................... ...... .... ....... .... .. ........... . ......... .. ....... ............... ............ ... ... ...... .... ... ......... .......... . . ........ .......... .... .............. ........... ........... ......... ............................ ................ . ............... ............ .... .... .... ....... Avised becembm zb .... ....... .....� 0. ....:.......... ... i G0 -AgT: INFORMATION .PLEASE PRINT LEGIBLY OR TYPE, PI«EASE:fNCLUDEA,N::EMAIL •: A licant. Nam s . r j t1llalling Address'c S/z: CO[PPhon Land Line S Ematl� ,i�, �• � �11� �. fir. •' :. Pri ary bwner(s): Names [� I�3 . .'�:� '" _... .. ... .... . IVlaiing Add ress;.;C/s/z � • It .CeII.:Phone;_( Land.Lirye;. _� ) _ — _ v Email. D CbQck if all work will be performed by property:owner ont. • 'CoritractOt ::::':;;::....... C-ContaetName{s Contri ctior. .6d6 MaiiErrg=:Address, C 5/Z:° iA F.r. . s � .. w s Cell Phone:_� '� Land Line:: !( ,,�j: — • .. .. . . . . .. ... ......... ... k , . . . . . mubittdyithhiappticatior ' *bm WosCp ri • :Engineer s . .. ...:... .. .... .Name .. . MailingAddress,C/S/z:.. . . _. . .. _... .................... . ...................:. ... . ... ............ ... . ........ ...... . land;lane:: Emai.l.... . _...._.. ......... .. ... Ccinta......sori for;Coimpliance n,regards.0.-th"_is project: cell Phone* Land Line: ...{.. :) Email. -NOTES.::1. Alarmsystem:.an:d asso:dated:electrical ork'.must.be] spected v.a Tc�wr� ap�raved°electrical . .................. . .:::. :.. inspection;agency;2;We vuill na longer allaw:s.stems.:to be.:covered until.suchti:rcie as..:an:as.-built:blan':is received and;approved.The installed system.must match the septic::lavout:on:file::no.cixceptions.°I.As- built`dr:.aviiings rriust:.i;e.submitted prior to.the:in'spectionr if- built: has been<a chi ge to the sial rriitterl' ......:: plans:4;'1fi;:for:any,reason',tf�e:b.r ildir g permit application is withdrawn:;3:(1° fi:tum fee:i.seta r ed.;:by the TbWri of Queensbury* After 1 yeaf f re:rn the initial[application date, lO O. f t a fee:is refaine- nectar ition::Ariy per :or. aPProval granted is..b.ased:upon:or is:granted in..reliance:upsin:.any rnateriat representation car failure to:make'a:material factor circumstance known by:or on beha. .0 an applicant, sh Ube v Ad t kiave rea,,,:,re ulations>at d a ree.:to abide bjr these and:::all requirement :of the TO W'** r f Qiaeensbuiy ..: . . . ....: ...... is !; $anitaty.Sewag isposal Ordinance: y PRtNT::NAi1/IE..- ..' Via' ..� ... � .�.' . .. .. ........... .:_... ar g ..................... ...... - >. s SfNATUf�E::�`' r... ..::T .s:g� C7 Tit.; .. ^bs.:/... SepiiC AppCication Revised:Qu,cember 2o2d Town Of Queensbury Interactive Mapper ,' -4_.•qLAA / 7 El 0-P © .. SUL:295.17 (7t SAWN Uj - L/ ;Z j 0WINER 90U'GL SALON" rr'' I'irl J` At r` Cm �- - - - Q L� CO SBL:235.17 i— T — UWh,'r=R:LY'NN i"a+TFLONE --- — ---- -- - - -- SEP-0700-2021 �--� ?� :.DAVID ® � E�� � Sawn, Douglas TO OF �u�E�SBDEPTe F 813 West Mountain Rd SUIT_©ING & CODES Residential Septic Alteration ®� Reviewed BY' o 295. t7-1-51 4 20 1 + OWNER:P",?ELODY PERRY r r1atP: Town Of Queensbury Interactive Ma pp er rIX Y� _�z���----�'---••_--.....,�..-.----,.t_—�.-�..s...-as-.s.- '�:"�_`,v,�+iia;�-'�� .';•'b�'�.,d:5 iAJ {aiTi 4[k'T�"3�) yap t✓ '-• SSL 295.17-1-4 p�r OWNER:DOUGLAS SAWN f �' t• � �e6�T` H . L:2 -'�-, 3 f Oi UGL SAWN rqM ��al z A ,d LL YY � Y SBL•295.17-1-1 OWNER:LYNN ArlILONE SBL:295-17-1-2 OWNER.'DAVID SAWN t M"AAMO.•■sct r°urry.