98-256 +CERTIFI+CATE 01 C+C>W �.IAI`�+CL�
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TOWN OF QUEENSBURY
WARREN COUNTY , NEW YORK
Date May 27 19 98
2Igo [ q �) . 5 91256
This is to certify that work requested to be done as shown by Permit No .
has been completed .
This structure �m�*ay be used as a yL�SEPTIC ALTERATION
Location E
Owner LEUFORD , JANET M .
By Order of Town Board
TAX MAP NO . 39 . - 1 - 45 . 1 TOWN OF QUEEN5BURY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE S a TOWN OF QUEENSBURY No. 98256
TAX MAP NO . 39 o - 1 - 45 . 1 WARREN COuNTV, NEW YORK
PERMISSION is hereby granted to LEDFORD JANET N .
OWNER of property located at L-4 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 Oueensbury Building and Zoning Ordinance.
t, OWNER'S Address is
ROCK. CITY RD .
HUDSON FALLS , NY 12839
2. CONTRACTOR or BUILDERS Name
CONDON SEPTIC & DRAIN SERVICE
3_ CONTRACTOR or BUILDERS Address
-R. narwlTce T^g Name
S. ARCHITECT'S Address
6. TYPE of Construction — [Please indicate by XI SEPTIC
I Wood Frame I I Masonry I ! Steel I !
7. PLANS and Specifications
SEPTIFIoALTERATION AS PER PLOT PLAN SPECIFICATIONS
oil
R Proposm Use
SEPTIC ALTERATION
25 May 15 2000
S PERMIT FEE PAID - THIS PERMIT EXPIRES 119
(if a longer period is required an application for an extension must be triad* to the Buifding and Zoning inspector of the
town of Oueens ury before the expiration data.)
15 May 19
Dated at the Town of Gueensbury this Day of 1S
SIGNED BY for the Town of Oueensbury
Building and Toming l
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury _ C7t
Dept. of Community Development .___ Permit No. _ "
Building 8c Codes Office
742 Bay Road MAY 15 1M Fee Paid $
Queensbury, NY 12804
T .
Location of property for installation: 1 Al B r
Property Owner's Name: I' r}J O -
Property Owner's Mailing Address: �6CC(' C! 7f"Cf II�� 3 r 5 + fl
Installer's Name: ��ry�1 � �+ + i7 Phone # -
Number of bedrooms (if residential) : ��-� Total daily flow: 360
(residential - compute 150 gal.Ibdrm.)
Topography: flat, steep slope % of slope
Soil Nature: sand, ++ '' loam, clay, other 1 depth:
Ground water: at what depth? VA feet 1 Bedrock or Impervious Material: at what depth1 feet
Percolation test: not required, required j rate ruin. per inch ]
Domestic water supply: X municipal, ->L well, other
If domestic water supply is a WELL, water supply from any
septic absorption is 2d _. feet.
PROPOSED SYSTEMSeptic tank:tank: 1600 gallon (rnini_murn/f size: 1 ,000 gal.)
Tile field: each trench r----- feet / Total system length: �— feet
Seepage pit(s) : number of / size each: ft. by .•-� ft.
Size of stone to be used: # „ 1 depth or thickness feet
- --- - HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
P.1arm system and associated electrical work to be inspected by a certified agency.
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 those and all regtu vwet is of the Town of
Queensbury Sanitary Sewage Disposal Ordinance,
Signature of responsible person:e z 0 Date:
TOWN OF QUEENSBURY
BUILDING CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name cx ry Q
Location
(� �7 r"I
Date �� Permit #
SOIL TYPE : Sand- Loam-Clay-
Results of Percolation est-
( if applicable ) Rate- to/ Inch
TYPE OF SYSTEM:
ABSORPTION FIELD : Tot l ength
Length of eac ranch
Depth of trenche
Size of stone
SEEPAGE PITS : Numbe
Size - fto x -
ft .
Stone size
PIPING: ,S�',ze e
Bldg . to Tank 6y _ 0
Tank to Dist . Box 11 N
Dist . Box to Fi el d
Openings Sealed ? Y No aarrt-i ai
LOCATION/SEPARATI
Foundation to Tank If+�/ feet
Foundation to Absorption Pe
eet
Separation of Pits eet
Conforms as per Plot Plan __ No
LOCATION OF SYSTEM ON PROPE
e one )
- Rear - eft Side Right Side
Middle Front - Mi ear
COMMENTS :
SYSTEM USE APPROVED: YES NO
Arrived :
Departed :
BuildingInspector
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