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1998-365 CLR,,r1 FICA rE OF COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY , NEW YORK Da t o 7 t4 26 --- 19 �$ This is to certify that work requested to be done as shown by Permit No . 98 35 5 has been completed , This structure may be used as a SEPTIC ALTERATION Location 144 WILDWOOD PLACE Owner COUGHLIN , ROBERT & MARY By Order of Town Board TAX MAP NO , 271 - 4 - 17 TOWN OF QUEENSBURY S Director of Building & Gode Enforcement BUILDING PERMIT VALUE $ 0 TOWN OF +QUEENSBURY No. 98365 TAX MAP NO . 27 . — 4 - 17 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to COUGHLIN , ROBERT & MARY OwlsiER of property located at 144 BOULDERWOOD DR . Street, Road or Ave. in the Tow of OueensburY. To Construct or place a SEPTIC ALTERATION Town 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 1RQ±tbW&D PLACE QUEENSBURY , NY 12804 x. CONTRACTOR or GUI LDER'S Nam+ STEVENSON ,, WALT 3. CONTRACTOR or BUILDER S Address f. ARCHITECT'S Name S. ARCHITECT'S Address G_ TYPE of Construction — (Please indicate by x) SEPTIC ( ) Wood Frame ( ) Masonry I ) Steel ( i 7, PLANS end Specifications SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS No. 8. Proposed Use SEPTIC ALTERATION 25 Junes 25 2000 $ PERMIT FEE PAID — THIS PERMIT EXPIRES , 19 fit a longer period is required an application for an exten"n inure be made to the Building and Zoning inspector of the town of Ouesnsbury before the expiration date.) 25 Junes 1998 Dated at the Town of Q2ueensburY this~� Day of 19 SIGNED BY for the Town of Oueensbury c$`ia id ing and Zarling laspecuo ApWication for SEPTIC DISPOS.AI, PERMIT Town of Queembury Dept_ of Community pevelopment Permit No. Building & Codes Office 742 Bay Road Fee Paid $ C" -� CJ CQueensbury, NY 12804 Location of property for installation: Vf/ l G es, two ad (� <r, Property Owner's Name: 13 © A e I, r r C) C) G A/ L It J UN - 2 5 IM Property Owner's Mailing Address: Installer's Name: Phone # ? 1? 3 ;` Number of bedrooms (if residential) : Total daily flow: (residential - compute 150 gal.fbdrnl.) Topography: flat, - rolling, steep slope % of slope Soil Nature: sand, C' � clay, other f depth,- Ground water: at what depth? feet f Bedrock or Impervious Material: at what depth? feet 19LsrA1' .3 ` .9C Percolation test: not required, required [ rate min. per inch ] e 6,c-� Domestic water supply: municipal, we other If domestic water supply is a WELL, water supply from any septic absorption is� feet. PROPOSED SYSTEM Septic tank: 000 gallon (minimum size: 1 ,000 gal.) Tile field: each trench s feet f Total system length: " a feet Seepage pit(s): number of f size each: ft, by ft. Size of stone to be used: # 01� / depth or thickness { r f feet HOLDING TANK SYSTEM: (if required) Number of tanks: Size of each, gallons Alarnn 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 miarepresentatio,r or failure to makes a material fact or circumstance ]mown 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 perso _• _ ✓tom`_ -' Date: TOWN OF QUEENSBURY ' a . BUILDING 6 CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Location [late to:c —9 3 Permit # SOIL : / Sand- Loam- lay- i Results of Perco ation Test- ; ( if app icable ) Ra - i ute/ Inch TYPE OF STEM. / ABSORPTION To L ngth Length of a rench Depth of t nches Size of one SE PITS : Number- Sze - ft . x ft . Stone size PIPING: Size Type Bldg , to Tank Tank to Dist . Box Dist . Box to F' i el d/ j!es ` .� Openings Sealed ? No a'�rtia� LOCATION/SEPARATION Foundation to Tank feet Foundation to Absorption feet Separation of Pits eet Conforms as per Plot Plan es o LOCATION OF SYSTEM ON PROPER ( circle one ) Front - Rear Le t Sid - Right Side Middle Front - ear COMMENTS : SYSTEM USE APPROVED : YES NO Arrived: Departed : Building Inspector a - p • as C p u COW CMD Omni V a ' Lim "' LLL •w. yaG' i I ! _ -__ ___ � __ . ._ __ _ . t ... ..... ... - _. 41 1 If . . .�. . f � 1 _ _ _ I 1 i im.a. c - r _ . , r _ � a _ oat" 1 fi -- - --- - - - - - - IF M24 _. � .. --g - - - -- f I I Ir ij I I