1999-286 BUILDING PERMIT
VALUE $ .0 TOWN OF QUEENSBURY No 99286
TAX MAP NO. :121 . -1-30 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to BOWMAN, ROBERT & MICHELLE
OWNER of property located at 496 LUZERNE RD. 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
496 LUZERNE RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
I.B.S. SEPTIC
3. CONTRACTOR or BUILDER'S Address
2 LOWER, WARREN_. STREET. .
QUEENSBURY:, NY 12804
4. ARCHITECTS Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( 1 Wood frame ( 1 Masonry" ""( 1 Steel ( )
7..PLANS and Specifications
SEPTII .ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use -
SEPTIC ALTERATION
$ 25 2001
PERMIT FEE PAID -THIS PERMIT EXPIRES May 26 19
(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.). .
26 May 19 1999
Dated at the Town of Quee bury this - Day of
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
• Application for SEPTIC DISPOSAL PERMIT .
it .
Town of Queensbury �Q�/
99286 121 . -1-30 _ (�(y/✓�
Dept. of Community Del,.;- BOWMAN, ROBERT & MICHELLE ! Permit No.
Building &Codes Office j
742 Bay Road { 496 LU Z ERNE RD. • - I Fee Paid _ex-,
Queensbury, NY 128O4\:it 'SEPTIC ALTERATION
Location of property for installation: [/21) � 2-c r Ae /\cC a�'
MAY261999
Property Owner's Name: 61
r r A? . c, TOWN
BU Lf� �tUEEiV5Bt1RY
Property Owner's Mailing Address: C.- )ter r-r�,r /` C''`IND CODE
Installer's Name: ,7, 8c c -" (fl�I c Phone # -2 7y r/ 2K
. Number of bedrooms (if residential): $ Total daily flow: rs---6
(residential -compute @150 gal./bdrm.)
Topography: fat, rolling, steep slope 90 of slope
• Soil Nature: s<nd, loam, clay, other /depth:
• Ground water: at what depth feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: /i not required, required [rate min. per uch]
Domestic water supply: ei municipai, well, other
If domestic water supply is a WFT.T, water supply from any septic absorption is feet. _
PROPOSED SYSTEM
Septic tank/POif) gallon (minimum size: 1,000 gal.)
i
Tile field: each trench A6-5-°feet / Total system length:? 0 0 feet
Seepage pit(s): number of / size each: , ft.by ft.
Size of stone to be used: # 7-- / depth or thickness ( feet
HOLDING TANK SYSTEM: (if required)
Number of tanl : : Size of each: moons
Clarm system and associated eIectrical work to beinspected by a certified agncr.
For yotn•protection, please note that pursuant to Section 136-29 of the Coda of the Town of Queens
approval gram which is based upon or is in reliance ', re permit or
granted � t�any material misrepreses�oa 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 re merts of the Town of
Queensberry Sanir.ry Sewage Disposal Ordinance,Signature of responsible person: (1 _ Date: if—d- (4 51
lil
' �' iuMm OF QUEENSBURY /
CODE ENFORCEMENT BUILDING Y- 1)
1 /1
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name QO\Q
!yA)O-Ap,,y)1
Location (� �,
Date L)- t --91 Permit # ''
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable Rate-Minute/Inch
TYPE OF SYS
ABSORPTION c I: LD: Total Length 2._CT)
Length of e.c` tre ch -DI
Depth of tre' ches 2-1
'L'
Size of stone • -
SEEPAGE PITS: umb:r-
Size - t. ft.
Stone size
PIPING: Size Type
Bldg. to Tank Li ", C.F9 _
Tank to Dist. Box _ L4R Rj
Dist. Box to Fiel 'i/Pit 1 , +t WcV-
Openings Sealed? 1 'e 'o Partial
LOCATION/SEPARATI,' :
Foundation to Tank ' IC) feet
Foundation to Abso ption - feet
Separation of Pits feet
Conforms as per Plat Plan Yes
LOCATION OF SYSTE ON PROPERTY:
(circle o e) --$
Fron - Rear eft S ' Right Side
Middle - ear
COMMENTS:
NEED1-186-90\L.�-, ?At
0V-Th ce:,P�
SYSTEM USE APP! . ED: YES NO
Arri • .:
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