98-693 TOWN OF QUE'ENSBURY
WARREN COUNTY, NEW YORK
IF Date October 29 19 98 II
98693
This is to certify that work requested to be done as shown by Permit Nov _
has been completed .
SEPTIC ALTERATION
This structure may be used as a --
Location -� DIX AVE ,
Owner LET"TUS , JAMES Noy SR .
TAX MAP NO Y Ile . - 2 - 5 By Order of Town Board
:70
OF QUE NS URY
-'
Director of 'Building B Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF +QUEENSBURY No. � 9869
TAX MAP NO . 110 . - 2 - 5 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to LETTUS JAMES M . S
OWNER of property located at
132 DIX AVE . Street. Road or Ave.
ALTERATION
athe Town of (cation in a To Construct or place a SEPTIC
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.
1. OWNER'S Address is
16 QUEENSBURY AVE .
QUEENSBURY , NY 12804
2. CONTRACTOR or SUI LOERS blame
3 I . B . S . SEPTIC
R 1TQd�" ARE4aTREET
QUEENSBURY , NY 12804
�. AF:CHIrErr� Nana
5. ARC141TECTOS Address
$. TYPE of Construct inn -- (Please indicate by X) SEPTIC:
( I Wood Frame I I Masonry f 1 Steel ( i
7. PLANS and Specifications
SEPT;q. ALTERATION AS PER PLOT PLAN SPECIFICATIONS
se, Prnposed Use
Y SEPTIC ALTERATION
25 October 29 2000
� PERMIT FEE PAID — THIS PERMIT EXPIRES
19
tat' a longer period is required an application for an eKtaniion must he made to the (;wilding and Zoning inspector of the
town of chmensbury before the expiration date.) 1998
29 October
Dated at the Town of +Qtieensbt+rlr this
Day of 19
for the Town of Queensbury
SIGNED BY
Buildirq a Zoning inspector
i
Application for SEPTIC DISPOSAE PERMIT
�r
'Town of Queensbury Permit No.
Dept. of Community Development
Building Sc Codes Office �
742 Bay Road 1 Fee Paid
Queensbury, NY 12804
Location of property for installation:
I
Property Owner's Name: Z%Ook r c..
�r ocTv 1998
Property Owner's Mailing Address: / ,
Installer's Nae: I m I /3 , �r . 00 %t ____ Phone # ^// " 994p t!
Number of bedrooms (if residential): Total daily flow:
(residential - compute Q 150 galJbdrm.)
Topography* t3at, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other I depth:
Ground water: at what depttAA� feet 1 Bedrock or Impervious Material: at what depth? . feet
Percolation testeA A� not req ' ed, required [ rate min. per inch ]
Domestic water supply: k0municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tankj/ 9 Q gallon (m;m-mum sue. 1 ,0QQ
Tile field: each trench feet / Total system length: taEQ� feet
Seepage pit(s): number of I 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 system and aasocu ted electrical work to be inspected by a certified agency.
For your protection please, now that pure a l to Sectiou 136-29 of the Code of the Town of Qoeembury, any permit or
approval granted which is based upon or is granted m reliance upCN2 any material r iarepresemixtion or f&ure to malm a
material fact or eircuxc etance known by or on behalf of an applicant, shaft be void.
I have read the regulations with raepect to this apph on and agree to abide by these aei all requnvmea4s of the Town of
Queensbury sanamy Sewage Disposal p
Signature of responsible person: Date: �i0 I "�
i � z
D3Q
TOWN OF QUE RY
BUILDING A CODE ENFORCE
742 Bay Road
Queensbury MY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
'0� 7v. - OL/2z -V
Name
Location �^�,
Date / (j � -'"L` Permit #
SOIL TYPE : Sand- Loam- Clay-
Results of Percol a ion Test-
( if applicable ) Rat Minute nch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tota ength
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS : er-
Size - fi : x ft .
Stone size
PIPING: Size Type
Bldg . to Tank
Tank to Dist . Box
Dist . Box to Field/Pit
openings Sealed ? Yes No Partial
LOCATION/SEPARATIONS : �,,
Foundation to Tank feet
Foundation to Absorption _36 feet
Separation of Pits l ; eet
Conforms as per Plot Plan es No
LOCATION OF SYSTEM ON PROPER.
( circle PPAW
Front - ea - CdiTeidar
- Right Side
Middle F t -
COMMENTS :
I
SYSTEM USE APPROVED : YES No
Arrived:
Departed :
Buiidin n actor
" have seen or � or 1
{ all have
such ass
eft
�, sh�pwn on b do n Nspu twomw RL
"b } �sd � sedrr# _
`ri c 5
M