98-260 q . I q � 1-!] I BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY
TAX MAP NO . 134 . — 6 - 39 . 2 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to BOMBARD , RONALD & SUS
OWNER of property located at 13 RYAN ST . Street, Road or Ave.
in the Town of Oueensbury, To Construct or place a SEPTIC ALTERATION
at the above location in accordance to application together with plot plans and other iinformation hereto filed and
approved and in compliance with the 'town of Oueensbury Building and Zoning Ordinance_
t. 016 MAAr sis
QUEENSBURY , NY 12804
2. CONTRACTOR or BUILDERS Hame
I . B , S . SEPTIC
3. °0PTf6 o$fti S WnET
QUEENSBURY , NY 12804
w. ra n.+'.."*I ii.C.'T0$ !:ante .
f>. ARCHITECT'S Address
6. TYPE of Con"ruc-tion — {Pleose indicate by X) SEPTIC
{ ) Wood Frame { ) Masonry { I Steel I !
7. PLANS and Specifieetlons
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
No.
a Proposed lose
SEPTIC ALTERATION
25 May 19 2000
S PERMIT FEE PAID — THIS PERMIT EXPIRES 19
I I f a "or period is required en application Ior an an tension must be mode to the 0uildIng and Zoning inspector of the
town of Oueensbury before the expiration date.)
19 May 19
Dated at the Town of aueensbury this day of 19
SIGNED BY c ,�/. "�C• ___for the Town of Oueensbury
BuIIdkV and Zoning I
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept. of Community Development Permit NO, TJ'"+2/0
Building & Codes Office
742 Bay Road Fee Paid $ .ZX5
Queensbuuy, NY 12804
Location of property for installation: 7 C
Property owner's Name:
Property owner's Mailing Address: ( y e.� r► ( d �'' .
Srr Phone #
Installer's Name: ,�,�• P . )[ f G
Number of bedrooms {if residential}: Total daily flow:
'' (residential - compute (0 150 gal.Cbdrm.)
Topography: s`.flat, roll ng, steep slope % of slope
Soil Nature: sand, loam, clay, other 1 depth:
Ground water: at what depth? eet C Bedrock or Impervious Material: at what depth? , feet
Percolation test: not required, required f rate min. per inch ]
Domestic water supply: municipal, well, other
If domestic water supply is a VVELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
E�LS / 4r
Septic tank: 600 gallon (minimum size: 1 ,000 gal.)
Tile field: each trench C.7 feet C Total system length: o� Q c > feet
Seepage pit(s): number of / size each.: ft. by ft.
Size of stone to be used: # C depth or thickness feet
HOLDING TANKS YSTEM: (if required)
Number of tanks: Size of each: gallons
Alarm system and associated electrical work to be inspected by a certified agency.
For your protection, please mote that pursuant to Section 136-29 of the Code of the Town of Queensbuiy, any permit or
approval granted which is based upon or is granted m reliance upon any material misrepreserntatKm or failure to make a
material fact or circumstance known by or on behalf of an applicant, &Mall 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
Quemenabury Sanitary Sewage Disposal Ordinance.
Signature of responsible person: � T Date: 7 r'
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
cstey 761-e256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date Permit #
SOIL TYP .�o m-Clay-
Resul is of Percolation Test-
( if applicable ) Rate-Minute/ Inch
TYPE OF SYSTEM:
ASSORPTI FIELD : Total Length Z
Length of ch trench
Depth of tre es t
Size of stone
SEEPAGE PITS : umber-
Size - ft . x ft .
Stone size
PIPING : Size ype
Bldg . to Tank E�tt
Tank to Dist . Box Psbc
Dist . Field/Pit el d/Pit y �r yti^ �
Openings
gs Seaea rt Sealed ? o aia -
LOCATION/SEPARATIi��"
Foundation to Tank Feet
Foundation to Absorption Z feet
Separation of Pits — feet
Conforms as per Plot Plan '--des f( �]
LOCATION OF SYSTEM ON PROPERTY:
( circle one )
Front Right Side
Middle Front - Middle Rear`
COMMENTS :
SYSTEM USE APPROVED: YE HO
Arrived:
Depart
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COP- C004000
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