2000-261 r i 1 P i . i.i i ..P.4 Fr tir. r • h r Jar rv.l t:� '4P r 1 1r. 1 e
Ulm C
jilianc,'*1
oml,,
flate Of
'own of Queensbury
Warren County,New York
May 21 2000
.Date
200 261
This is to c1"' ythat work requested to be done as shown by Permit No,
has been completed,
SEPTIC ALTERATION
This structure maybe used as563 �aUTU g�_
Location
NARINCIC, VIVIAN ESTATE
Owner
TAX NAP NO, 123. -1-11 . 1
By Order Town Board
`O OF B
Director of Building&CoderEnforcement
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 0 Building Permit No. 2000261
TAX MAP NO. 12 3 . -1--11 . 1
Permission is hereby granted to MAR INC I C, V I V I AN ESTATE
Owner of property located at 563 WEST MT. RD.
in the Town of Queensbury,to constructor 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 NYS Uniform Building Codes and the Queensbury Zoning Ordinance.
Owner's Address:
BARBARA MARINCIC 242 MEADOWBROOK RD.
QUEENSBURY, NY 12804
Contractor or Builder's Name:
I .H. S. SEPTIC
Contractor or Builder's Address:
2 LOWER WARREN STREET
QUEENSBURY, NY 12804
Electrical Inspection Agency:
Type of Construction:
SEPTIC.
Plans and Specifications:
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
Proposed Use:
SEPTIC ALTERATION
s 25 PERNITT FEE PAID—TMS PERN[T EXPIRES May. 2 2002
(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 the wn of Queensbury this 2 Day of May 2000
SIGNED B for the Town of Queensbury
Naj o Enforcement 6mcer
ApplicAtiol, for.Permit-Septic Disposal System
7011,11gf Queeltsbi"y 742 Bay Road Quierlsbuiy,NI' 12804 (518) 761-8256
1. OWNER INFORMATION: /
Location of installation: _= 0 _......_..... _...... .._.....e a................................._.
_ ..... ....
Office Use
Tax Map No. 0/
File horinit-No
Owner's Name:- 9 Mt / 1� >� C' L G Fee Maid
.........................................:.............................................................
....
.Address:
2. INSTALLER'S NAME // �- - PHO C�
r/�i l�. " tf�%�G � NE NO.7/�6
7
3. RESIDENCE INFORMATION: (circle year of dwelling, indictite #Get/ruont(t) and multiply JI v}'
bedrooms with applicable g'allons her bedroorii to equal total daily fl(Aw)
Year of House: No of Bedroottis x Computation - Total Daily Flow
1980 or older x 150 gal/Gdrni = S O
1980- 1991 x 130 gal/bdnn = VE
1991 -present x 110 gal/bdrin =
Garbage Grinder Installed yes / no MAY 0 2000
Spa or Whirlpool Installed yes_ / no TOW d OF O'i. E-04dSt3RY
BUILDING AND_g0QE
4. PARCEL INFORMATION; '(circle applicable information 8c indicate uteasurements)
pl 1-519 ure Grou�td Water I3edrobk or Ittrucrvious Material ter SthtrlX
at .ran at sv r depth tit,t�vJI�y�epill nrruitclpal
of/ing oam' feet s"`1 L_1i et t
'Sleep slope clay t well; tvater,sitlrlrly
./v slope other f�ioln any septic-ijistem
depth: absorption is_,00
other'
Percolation Test: (To be eonipleted by licensed professional engineer or architect)
Itatc�: minute per inch
5. PROPOSED SYSTEM: Tor New Const uctiot All individual sewage disposal systctus must be designed by-a licensed
professional engineer or architect(unless installed in a Planiuug'Board approved subdivision).. Add 250 "gallons to the size
of the septic lank-air leach field for each Garbage Grinder,Spa or Whirlp ool'rub.
/
Septic Tank: 6 Qt`�c3 gallon(min, size 1,000 gal.)
Tile Field: each trench. S it. Total System Lerigth: c fit,
Seepage Pit(s): number of size of each: J/t. G_y
Size of Stone to be used: !l / depth or thickness / jeet
Bed System Size: z
-Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of eaclt: 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 Qtieensbury,any perinit or'approval granted which is based upon or is granted in
reliance upon any material tnisrepresentatioit or failure to make a niatcrial'fjct or
circutnstauce known by or oil behalf of all 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.
4Wnature of respons le person Date
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"I have seen or observed,or believe I saw evidence of,
UIOBNG ' all objects such as houses,wells,trees,fences,etc., .
RE-VIEWED F"Y shown on this document, I also',represent that I have
DATE personally easured the distances set forth on the diagram."
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