2002-023 TOWN OF' OUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
CE."Dft'j'. IFICA"m1"E OF COMPLIANCE
Permit Number: 'P20020023 Date Issued: Thursday,January 10,2002
This is to certify that work requested to be done as shown by Permit Number P20020023
has been completed,
Tax Map Number: 523400-308-018-0001-083-000-0000
Location: 40 REVERE Rd .
Owner: ALAN&JANICE EICHER
Applicant: A,AN&JANICE EICHER
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN or QUEENSBURY
Director of Building&Code Enforcement .
TOWN OF QUEENSBURY
742 Bay Road,_Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020023. Application Number: A20020023
Tax Map No: 523400-308-018-0001-083-000-0000
Pertnission is hereby granted to: ALAN &JANICE EICHER
For property located at: 40 REVERE.Rd
in the Town of Queensbury, to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: ALAN& JANICE EICHER . Septic Alteration Residential
40 REVERE Rd Total Value
QUEENSBUR.Y,NY 12804
Contractor or Builder's Name./ Address Electrical Inspection Agency
CONDONS SEPTIC & DRAIN SERVICE
Plans &Specifications
2002-023
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,January 10,2003
(Ifa longer period is required,an application.for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date)
Dated at the o' Que sb ry; sday,January 10,2002
SIGNED BY for the Town of Queensbury.
Director of Building&Co e Enforcement
Application for Permit-Septic Disposal System
Town of Queensbury 742 Bqv Road Queensbury,NY '12804 (518) 761-8256
1. OWNER INFORMATION: ............................ ......................
Office Use
Location of installation:
File Permit No.
Tax Map No.
Fee Paid
Owner's Namea��, �11r ............... ................---------- .......................-------........... ...............
Address:
2. INSTALLER'S N AME /V &�l PHONE NO.�_
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate 4 bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Com
putation = Total Daily Flow
1980 or older x 150 gal/bdrm = �42 IQ
1980- 1991 x 130 g4l/bdrm
1991 -present x 110 galfbdrm
R,FK
Garbage Grinder Installed yes J no J A K 1 3 52
Spa or Whirlpool Installed yes no
TOWN C)F:C)UEF-NSBURY
4. PARCEL INFORMATION: (circle applicable information&indicate measurements) BUILDING AND CODE
Soil Nature Ground Water Bedrock or 162pervious Material Domestic Water Su
lat' --s�n at what depth at What depth jc:municipal
To -
Rolling .- -a-m— feet feet well
Steep slope clay if well;water supply
Yo slope other from any septic system
depth: I absorption is
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: _:__ minute per inch
5. PROPOSED SYSTEM:" For New Construction: All individual sewage disposal systems must be designed by a licensed
professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
V600
Septic Tank. gallon min. size 1,000 gal.)
1-7
Tile Field: each trench ,90 ft. Total System Length: > fit.
Seepage Pit(s): number of size of each: _ft. by_ft.
Size of Stone tobe used: depth or thickness feet
Bed System Size: X
Alternative System: length andlor size
6. HOLDING TANK SYSTEM: (if required)
Number oftanks: Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
For your protection,please note that pursuant to Section 136-29 ofthe 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 behalf of an applicant, shall be void.
I have read the regulations with respect to this application and agree to abide by these and all
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible person Date
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TOWN OF QVEENSBURY
BUILDIN'111)111E
,I have seen or observed,or believe I saw evidence of,
all objects such as houses,wells,trees,fences,etc.,
shown on this document.I also represent that I haveia ram:'
p rso Ily�me ured t e distances set forth on the diagram.
SIGNATURE DATE
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-------� BUILDING �T,
REVIEWED BY
DATE
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