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2000-204 BUILDING PERMIT Town of Queensbury, 742 Bay Road, Queensbury,NY 12804 County of Warren (518)761-8256 VALUE $ 0 2000204 TAX MAP NO. 130 . -3-21 Building Permit No. WAKELEY, PAUL A. Permission is hereby granted to 11 MAIN ST. Owner of property located at SEPTIC ALTERATION in the Town of Queensbury,to construct or place a at the above location in accordance to 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. 6 9v-0P1is9WAQsSAVE GLENS FALLS, NY 12801 ATftorS%PqT8V'ffA* IN SERVICE Contractor or Builder's Address: Electrical Inspection Agency: Type of Construction- SEPTIC. SPPTT8dk%i6ffON AS PER PLOT PLAN SPECIFICATIONS Proposed Use: SEPTIC ALTERATION 25 April 17 2002 $ PERMIT FEE PAID—TIHS PERTVHT EMPIRES (If a longer period is required,an application for an extension must be made to the Code Enforcement Officer of the Town of Queensbp7 before the expiVn I .pr r", 2000 Dated at the To of Queensbury this Day of SIGNED BY for the Town of Queensbury Code Enforcement Officer Application for Permit-Septic Disposal System Town qf Que-ensbuzy742 Bay Road Queensbury- NY�1?$04 51 761-8256 ~ I._OWNER INFORMATION:• ,. Location of installation: c�I ............ Office Use. Tax Map No.,r t . . , 4 •'File Penuit No 1 � pp', j� J ,Fee Paid Owner's Natrie: � � {.C/ L l-t-/` . ... --- Address: � � '/U / c✓�__ (� it�'� I�a �J � 2, INSTALLER'S.NAME (y tU o16 m, rC 7F d tit 2 o- iiac PHO-Nt NO. 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate Abedroom(s)and multiply# of. bedrooms with applicable gallons per bedroom-to equal total daily flow) Year of House: No. of Bedrooms x Computation-' - Total Daily Flow- 1980 or older Z_ x 150 gal/bdnn = 1980—1991 x 130 gal/bdrm = � � 1991 —present x 110 gal/bdrm _ ' ED Garbage Grinder Installed. , yes / no_� APR 1. 7 20�0 Spa or Whirlpool Installed yes / no 3'C)ttlf',A OF 01JE-E�9SBt9F1'i/ BUILDING/-I&4D GOn 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply at ZYE25 at what depth at what depth (Eu:nici g Rolling loam feet f_l�&_feet well Steep slope 'clay if well; water supply slope other from any septic-system depth: absorption is ft- other ____Percolation Test:,_ To be.co�npleted by lice»sedp,ofessiaxral enginPer,or - Rate: nunute per inch.- 5 PROPOSED SYSTEM: For New Constraction: All individual sewage.disposal systcins must be designed by a licensed professional engineer or architect(unless installed in a Planning Board'approyed subdivision). Add 250 gallons to the size of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. Septic Tank: t e o o gallon (min. size 1,000 gal.). Tile Field: each'trench ft. Total System Length: fi Seepage Pit(s): number of size of each: ft. by ft Size of Stone to be used: # / depth or thickness feet -Bed System Size: x Alternative System: length andlor size 6. HOLDING TANK SYSTEM: (if-required) Number of tanks: / 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 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 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 � � ��rracn � �rod�I� gtncncncnvrA �l�� � � r z C�p (DO 00 ,a H(+ -r, m -,, (D p CU p a Qd ..t. n3o t~ C n (D 0 :1 aTa N rlN -0 3 (A C+ 0 ?3 )"t0) 33 3 � r� xcQ H� (D `9(Dct� � � c r n� a rD M j(t0 ,gyp "1 p, Q, ��r ZN � 3'ct a Z M - t~1 a a a H (+- G) 1 00 T C�'Q rt •� � -� GO „ ctctc toQ r;ti , Mt 0 -411� ua H ut 0 Q � -� 0 H -� . `� ° n " } p p p SoX 0 N 5,F 3 r Zi a a Oleti f a �' p lac � 0 0 � � b 0 33 0 `� m a ND � G �. M � N � 0 ct (D ,� n Am p. M (D (D (D (D -�, (D oo f D p rh C+ ct a , Lol i 1 4-1 4 I I d , • 7 't7 tf� ra — a �uN w a �' � I . w © U1 C) n cn Lf) o� Na' co N A• 7-" APR 17 2000 1 OWN E: RY z�e��e� 130 - - 1 Toh,�'�,i r,�.0�1'"- I�u;�:���� ��. � � � � ��� �'ITp 11 MAIN ST,WAKELEY EilIEVED$Y SBPfiIC AbfiBBpfiIdN ^ DATE /n) QO f4/jt yr