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2002-296 TOWN OF QUEENSBURY !1 \ 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020296 Application Number: A20020296 Tax Map No: 523400-308-017-0001-052-000-0000 Permission is hereby granted to: CHARLES & FRANCES BALDWIN For property located at: 148 WEST MT. 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: CHARLES &FRANCES BALDWIN Septic Alteration Residential 148 WEST MT.RD. Total Value QUEENSBURY,NY 12804 Contractor of Builder's Name f Address Electrical Inspection Agency ACTION SEPTIC/CHET SANDERS Plans &Specifications 2002-296 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFCATIONS f k $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,April 24,2003 (If a 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 th To f Q ns nesday,April 24,2002 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for I'ergtit-Septic Dispc sat System Ybivirof Qticensbrity 742.13cty ionic Queensbury,NJ' 12804 (518) 761-8256 1. OWNER INFORMATION," // .......... '.......................... .. ........._...................... ........_. Ol ice Use Location of installation: " /� —y File Permit N Tax Map No. Cob Owner's Name: C � t"/�i /C-�il�C/1'1`�✓ . :Fo© Pnld.. Address: a� a......... ` �/ 2, . INSTALLER'S NAME l 'f'� 7' r dfiG�.0 /�r — PHONE NO,Z_ Z 3, RESIDENCE INFORMATION: (circle year of dwelling; indicate h heidrootn(s) and inultiply 11 of- - bedroonrs with applicable gallons per bedroom to equal total daily flow) Year of Iio �~" No o£BodrvotLts x- t✓Ompul_(iotl ~ " Total Daily Flow 980 or older x 150 gallbdrtn 1980. — 1991 x 130 gai/bdrnt 1991 --present x 110 gal/bdrin = Garbage Grinder.Installed yes / norms' Spa or Whirlpool Installed yes Y -no , 4. PARCEL INFORMATION: .(circle applicable information 8a i r- Measurements) , til tsity c3.�otrnd_l?4''ritos�: _Dpsl,roctc.vrJiuporviatt&1wt�.to''� ._Qotr; s ic -ttv!':S.[ri�t�ly <`L q1 rcrrtd err what tlepth 'crt whim thAOR 2-s3. 20 i►rr�irJal/sir'' Ilalllrtg locum feet feet we steep slope clay if►od/1 water supply �t:3Vili�l OF ta?I.IEEdgSF3l1F't _i6 slope outer r4l s:�..€ Al rt �ti�l f;ppE front arry septic-system depth: absorpiton is fl. other Percolatioti Test: (To be completed by licensed professional engineer or architect) Rate; 1111tittte per-inch 5. . PROPOSED SYSTEM: ror Now Construction:- All individual"sewage disposal-systcins must be designed by o licensed profession.lUcnginccr or arch tcct{runless inslnllcd in,:i Planning Boatel approved sub division). Acid 250 g:dktns to the sirs of the septic;:hink and lcaclt field far c:rclt C;arbige C}tindc'r, Spa or Whit pool l nb. Septic Mink: L!�zs�gallon (Min. size 1,000 gal.) Tile Field: each trench fl. Total Systoin Length: fl: Seepage Pit(s): number of size rifeaclr ft. by Sloe o£sEone to;be timed: .lt _-- ! eta/�tlr ur I/►lcktteax,— -.__...___I' et Bed System Size: x Alternative 5yntom: length andlor size 6. HOLDIN.G TANK SYSTEM '(if required) ` Numher oftaitks: 1 Size of ea eh: gallons %TOTAL Capacity: gallons Nate Wartn;Systein_atnd associated electrical work'tntt"st"be inspected by a Town approved "electrical inspection agoncy.. 7. . - SIGNATURE 4 INFORMATION FOR RESPONSIBLE PERSON (please read) Igor yotir protection, ptonse note that ptwi•siti►nt to Suction 136-29 oCilto Code of Iho Tow".6CQueoristittry, any pertatit or npllrovnt gr`nilted wltict� is based upon or is granted in r'.biinttcu t ton any n�atoriar misrer�resontatioi► or failure io"'ntako a ttinterial factor., circurtistance known-by or on bcbnlfor"arcappiicaut;sli;till:'bo void'. l haveypitd tho iegutntions with respect.to this npplicotiort-arid agree to abide by those and+till requirements ofthe Town ?f Queensbory, . iitary'Sowage Disposal Ordinance. griature of responsible person~ Dete j (0' 4J. 4J +) 0 O !Z � 4JO O O� '� � 4. 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