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1999-177
BUILDING PERMIT 30I tao-1- OF QUEENSBURY VALUE $_- 0 TOWNNo. 99177 TAX MAP NO. 119. -6-22 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to COLOMB, DAVID & DEBRA OWNER of property located at 12 HERSEFORD LANE Street,Road or Ave. in the Town of Queensbury,To Construct or 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 Town of Queensbury Building and Zoning Ordinance. 1. OWNER'S Address is LOT 22 HERSEFORD LANE. QUEENSBURY, N.Y. 12804 2. CONTRACTOR or BUILDERS Name COND.ON: SEPTIC & DRAIN SERVICE 3. CONTRACTOR or BUILDERS Address 4. ARCHITECT'S Name 5. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) ( )Wood Frame ( )Masonry ( ")Steel" ( 1 7. PLANS and Specifications SEPT,IaC:.ALTERATION AS ;PER- PLOT :PLAN SPECIFICATIONS ,,_. 8. Proposed Use , SEPTIC ALTERATION :25•_•. ,. .Apri.l , 27 ..._._. . . . . 2001. :: $ PERMIT FEE PAID _THIS PERMIT EXPIRES - (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Queensbury before the expiration date.) . - ......27•.:,,_ Dated at the Town of Queensbury this y of " SIGNED BY for the Town of Queensbury uilding and Zoning Inspector -r, _ _ __, ippneaiiull Jul oral- 11k.. 1J10r'J .r r cIVll 1 . Town of Queensbury Permit No. 9 < [ Dept. of Community Development 7 Building &Codes Office ii ECENEF 742 Bay Road Fee Paid $> Queensbury, NY 12804 APR 2 7 1999 nu 'aSBUR`� - — J Location of property for ins . . y� ® A' 'r �'� o! —/41'll Property Owner's Name: P F g-g f E.4 DA V(b (DO ell z - 7yr.- /Q3 Property Owner's Mailing Address: 1 2.- WcEUS co ik p A}M/E Installer's Name:(I?/d©,j r Jp ,�e f /9//'l)SFA7i Phone # 7if�P/z- Number of bedrooms (if residential): 3 Total daily flow: , , ,c) (residential - compute 150 gal./bdrm.) Topography: g flat, rolling, steep slope % of slope Soil Nature: K sand, loam, clay, other /depth: Ground water: at what depth?/_ feet / Bedrock or Impervious, Material:, at what depth-%feet Percolation test: X not required, required [rate min.per inch] Domestic water supply: '( municipal, well, other If domestic water supply is a WELL, water supply from any septic absorption is feet. LSF '(tC PROPOSED SYSTEM , Niger-, I ey<<S-, f -VA0 Septic tank: gallon (minimum size: 1;000 gal.) Tile field: each trench ,O , feet / Total system length: 36 0 feet Seepage pit(s): number of / size each: ft. by ft. 1i Size of stone to be used: # - / depth or thickness is feet HOLDING TANK SYSTEM: (if required) ' Number of tanks: Size of each: gallons &farm system and associated electrical work to be inspected by a certified agency. J 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: P Jr 133/ E ( of okn `! Lon/foam —,cr� c L. Cv�/"r -�cic 2- f�F FS � D - 7YT 1 Q3� 1.L—'`_ GRAB ( ME 'le-..8-5^ GoA,'s //) /�-'o 3c.......S\/\/-f\t0‘, ( ecE vsaus-Y 11), y {_may �j�S ser- t�0 11 too Co��r e) 097 / 7 ,,,,,,,,,,:.., ,-. „-- , 9 ,,,,,,,?.. , ,-, 13 ,, ,,,030,v,0 . ,,,,,,-Li,,,,,,,„,,Gor, . . ..___. , , v ,,A,._____09------ , ..,... er FP 0 1 D-b G 61 < 6! • b K TOWN OF QUEENSB Y - IZI__ l'Z., • ?;r‘ , . ., REVIEWED BY - BAR DATE . "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 have - T FILE copy personally measured the distances set forth on the diagram.". TOWN o�QUE��IS�t!R;l:al+�:�o��P�,IZT�I� �/J _�Y��v Based on oa r with our comments shall `1,- DATE compliance w SIGNATURE not be construed specif as indicating the plans and specifications are in full• compliance with the code.