98-370 BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 9R370
TAX MAP NO . 122 . - 2 - 6 . 7 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to CONVERSE F TAURS &
OWNER of property located at 4 C HEROKEE J �ANE Street, Road or Ave.
in the Town of Queensbury, To Construct or place a SEE2: I r' Af -TE'RAT I CW
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
4 CHEROKEE LANE
QUEENSBURY , NY 12804
2. CONTRACTOR or SUILMR"S Name
I . B . S . SEPTIC
3. CONTRACTOR or BUMDER'S Address
2 LOWER WARREN STREET
QUEENSBURY , NY 12804
4. ARCHITECT'S Name
S. ARCHITECT'S Address
6. TYPE of Construction — {Please indicate by Xl
SEPTIC
{ 1 Wood Frame I I Masonry I l Steel I I
7_ PLANS and Specifications
SEPTAg ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 Tune 26 2000
PERMIT FEE PAID THIS PERMIT EXPIRES 19
(if a longer period is required an application far an exmosian must be mede to the Building and Zoning inspector of the
,town of Chwansbury before the expiration date.)
26 Tune 1998
Dated at the Town of Queensbury this Day of 19
SIGNED BY ` *�* --- for the Town of Oueensbury
eutwing a nine Inw000r
Application for SEPTIC DISPOSAL PERMIT
Town of Quemsbury
Dept, of Community Development Permit Na. 7 f )
S Wiling & Codes Office ` � +�
742 Bray Road Fee Paid $ k5
Queensbury, NY 12.804
Location of property for installation:
5
Property Owner's Name: �. {M JUN
t�",���gg[��( .G�'�'��' C
Property Owner's Mailing Address: �� ('f�s { .
-Installer's Name: , �} r ,r� ;_�� Phone #
Number of bedrooms (if residential): Total day flow:
(residential - compute 0 150 gal./bdrm.)
Topography , mpg, steep slope % of slope
Soil. Nature: �`+ sand, loam, clay, other / depth:
Ground water: at ,w{h/atepth?/feet I Bedrock or Impervious Material.: at what depth? feet
Percolation test: /`v f not required, required [ rate min. per inch ]
Domestic water supply: 4?Cinwnicipal, well, other
If domestic water supply is a WELL, water supply from any septic absorptions is feet.
PROPOSED SYSTEM
Septic tank: ) gallons (minimum size: 1 ,000 gal.)
Tile field: each trench "� feet I Total. system length:" feet
Seepage pit(s): number of cry. ! size each: ft. by ft.
Size of stone to be used: # / depth or thickness feet
HOLDING TANK SYSTEM: (if required.)
Number of tanks: Size of each: gallons
Alarm .yatem and associated electrical work to be inspected by a certified agency.
For your pmtedtion, please note that pursuant to 3ecbce 136-29 of the Code of tie Town. of Queensbury, any permit or
approval granted which is based upon or is granted in reliance upon any material misrapreseatebion or f inure to we a
material fact or ircuzn■tan known by or on behalf of as applica to rhall be void.
I have read the regulations witb respect to this appliccabon amd agree to abide by/these and aII requirmwe"s of the T/ov*lm of
+(�iae an.b�usy Sanitary Sewage Disposal, Chdinanca..rC If! r .�.A' '�
h- r .. .
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FILE Copy-
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DATE
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orbAmIsnoillemet
bM waft, bees, fences, etc.,
Q 7 stew 6mment. I also represent that I have
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DATE
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TOWN OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
742 Bay My Road
12804
Queensbury
(518) 761-8756
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date +�0- Permit # r �5 7 d
SOIL TYPE: Sand- oam-Clay-
Results of Percol tion Test
( if applicable ) Ra a-Minut Inch,______
TYPE OF SYSTEM: tal L gth
ABSORPTION FIELD :
Length of each tren h
Depth of trenches
Size of stone
SEEPAGE PITS : ft, x .fit
Size "
Stone size - size~ ype
PIPING:
Bldg . to Tank ~--~-
T k to 'Dist . Box -- -u
1 st . Box to Field/ t
Openings
Sealed ? Yes No arti a
LOCATIONISEPARATI feet
Foundation to Tank ti on �~ feet
Foundation to Abs rp feet
Separation of Pit Yes No
Conforms as per of P anPRO TY `
LOCATION OF Sy ON
( circle Rear - eft Side - fight Side
Front i ddl a Rear
Middle Front -
COMMENTS : t� []
SYSTEM USE APPROVED=
YES O
Arrived:
Departed =
Buy I I ng nspector
Town OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
742 Bay Road
Queensbury MY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date Permi :570)
SOIL TYP "Sa - Loam- C1a Results of Percolation Te t-
( if applicable ) Rate-Minut /In h
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Le t
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PIT_ •: Number-
- ft ,
Size x ft .
Stone size
PIPING : ize Type
Bldg , to Tank
Tank to Dist . Box co
Dist . Box to Field/Pit +u "
Openings Sealed ? Ye arts
LOCATION/SEPARATIONS :
Foundation to Tank feet
Foundation to Absorpt on feet
Separation of Pits eet
Conforms as per Pl o Plan a No
LOCATION OF SYSTEM PROPER
( circl e
Front Re Lef Side - Right ide
Middle Front - Mi le Rear
COMMENTS :
I t
SYSTEM USE APPROVED : YES N0
I
Arrived:
Departed :
Building Inspector