98-560 BUILDING PERMIT
VALUE $ TOWN OF QUEENSBURY Ala, � 8L56{A
TAX MAP NO . 74 . - 1 - 26 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to RAYNQR Tt'ENNETH A Er TSIE_
OWNER of property located at 1079 WEST Street. Road or Ave.
in the Town of OueensburY. To Construct or place a
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.
t. OWMER'S Address is
1079 WEST MT ., RDII,
QUEENSHURYr NY 12804
2. CONTRACTOR or SUI LDER`S Name
QUEENSSURY SEWER
3, CONTRACTOR or SUiLDER'S Address
JAY SWEET
0
4. ARCHITECT'S Name
S. ARCHITECTS Address
S. TYPE of Construction — tPlesse indicate by x} SEPTIC
I I Woad Frame I ) masonry ( 1 Staei t }
7. PLANS and S eclfications
SEPXIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
S. Proposed Use
SEPTIC ALTERATION
2 11 5 September 10 2000
$ PERMIT FEE PAID — THIS PE14MIT EXPIRES . 19
(If a longer period is required an application for an extension moat be mad@ to the Budding and Zoning inspI of the
town of QueensMury Fore the expiration date,}
10 September 1998
Dated at the Town of Queenoury this _ Day of 19
SIGNED BY
for the Town of Queensbury
Building and Zoniry} Inspacxar
Application for SEPTIC DISPOSAL PERMIT
Town of Qaeeosbury ^I
Permit No.
Dept. of Community Development
D
Building & Codes Office r'] o
742 Bay Road Fee Paid $ tnA� w
Queensbury, NY 12804 r-�
Location of property for installation: / � ` 4 tkd� .�S i yh*
Property Owner's Name: _ L< e Vti LCA. lrf ►'1 ic) r"
Property Owner's Mailing Address: P,_�
Installer's Narne: JQ 0- v' Phone #
Number of bedrooms (if residential): Total daily flow:
(residential - compute Qa 150 gal./bdrm .)
Topography: k, fiat, rolling, steep slope To of slope SE P 6 (71998
Soil Nature: ^, sand, loam, clay, other 1 depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: .>L not required, required [ rate min. per inch ]
Domestic water supply: >C municipal, wen, other
If domestic water supply is a WELL, water supply from any septic absorption is feet,
PROPOSED SYSTETu�����
Septic tank: gallon (nuturnum size: I ,000 .al.)
Tile field, each trench feet / Total system length: feet
Seepage pit(s): number of �?_^ 1 size each: ft lay t D ft.
Size of stone to be used: # I depth or lzickriess 2, feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
AIarut system abd associated electrical wnrk to be jasp * by a certified agency.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town. of Qaeensbary, any permit or
approval granted which is based upon or is granted in reliance upon any ataterial misxelareseut'60n or fmausa to mace a
material fact or cj=awstance known by or on behalf of an applicant, shall be void.
I have read the regulations with rewect to this application and agrees to abide by these and all rvquuv eats of the Town of
Queernsbury Sanitary Sewage Dialwsal 0113i0a"Ca.
Signature of responsible person: . Date: S 4f / !1
TOWN OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location 79` Al,
Date Q Permi t
SOIL 7YP an Loam- Clay-
Results of Percolat on Te
( if applicable ) Rate Minu e/ I ch
TYPE OF SYSTEMI
ABSORPTION FIELD : Tota L ng
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PIg Number-
Size - ft � ft .
Stone size ,�
PIPING . ize
Bldg . to Tank
Tank to Dist . Box .ci ¢
Dist . Box to Field/
Openings Sealed? Yes No a�t a
LOCATION/SEPARATi
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan es No
ION OF SYSTEM - ON PROPERTY
c c one )
Fro - Rear - Left Side - Right Side
i dl a Front -- Middle Rear
COMMENTS :
SYSTEM USE APPROVED : YES NO
Arrived :
Departed : ,•
Building Inspector
SEP /0 J998 c,c4..j ez
ty
HLE COPY
how 2"" or dMMp"A
all ob** $M* la
Ow" Oft thig
a y
NL
TOWN OF
Bull
TOWN OF QUEENSSURy BUILDING DEPM ENT
Based on Our limited exami"atkM,
DATE
compliance with our comments Mall
not be construed as indicating the
Plans and specifications are in f4j[l
Compliance With the code.
42