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BOTH-000520-2016 o � U O s„ c W d � v O c m 00 Cd 0 v W � U s Cdo v o �' O ro © H a -o C)Q co - c N -j o a cC air E CD a' z o z u a o 0 o a. o a� 4 � � � � a TOWN OF QUEENSBURY ( f 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: BOTI I-000520-2016 Tax Map No: 303.10-1-75 Permission is hereby granted to: Ronald DuFour,Tonya DuFour For property located at: 16 LYNN AVE In the Town of Queensbury,to construct or place at the above location in accordance with application together with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance Tyne of Construction Owner Name: Ronald DuFour Septic Disposal $0.00 Owner Address: 16 Lynn Total Value $0,00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Howard's Excavating 470 WEST MOUNTAIN RD Queensbury,NY 12804 Plans&Specifications Septic Alt. $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,August 4,2017 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbu before the a iration date.) Dated at the Town Queens u 4Tue d ust 9,2016 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement SEPTIC DISPOSAL PERMIT Office Use Only a DATE G fp Received I_ r ljr ` Tax Map ID TAxMAP ID " CP—L Permit No. L S --LL' Permit Fee �' O O LOCATION OF INSTALLATION N L�` Approvals: C � `Y '/ PHONE/E-MAIL � APPLICANT I 0 �Y.�!/! `� J I / � I i �� __ ADDRESS INSTALLER/BUILDER: PHONE/E-MAIL Z 2 —7 � t ADDRESS: l OWNER 1 L/ � / J , 1 PHQNL/E-MA& Address CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: PHONE RESIDENCE INFORMATION Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow 1980 or older Garbage grinder installed _Y 1981-1991 Spa or Hot Tub installed Y 1992-Presentt Ll f r r PARCEL INFORMATION Topography Flat rolling Steep slope —%slope Soil Nature Sand Loam Clay Other Groundwater At what depth? Bedrock/Impervious Material At w depth? Domestic Water Supply Municipal Well (if well,water supply from any septic system absorption is_,ft.) Percolation Test Rate: per minute per inch(test to be completed by licensed engineering/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION Tank Size f�gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub) System Type Absorption field with#2 stone Total length ft.; Each trench x Seepage Pit with#3 stone How many: —;size Alternative System Bed or other type? I Holding Tank System Total required capacity? Tank size of tanks Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer allow systems to be covered until such time as an As-Built plan is received & approved. The installed system must match the septic system layout on file–no exceptions. DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or failure to make a material fact or circumstance know by or on behalf of an applicant, shall be void. I have read the regulations and agree to abide by t e e anq all requirements ofTown of Queensbury Sanitary Sewage D' os Ordi n Print Name: P'( &� '� Date: Signature: 4.1 , 4Z Date: Town of Queensbury Building&Codes Septic Disposal Permit July 2014 AUG �g 2<J16 �M'L� COPY Z AC�flITIarJPtL Zl>I EQ7E0 IN-pj�}I 41.43 t O I O-M RT LE-RC" U O SEPTIC_ 'LOT I HAVE S EN OR OBSERVED ALL OBJECTS Q I I I SUCH AS USES,WELLS,TREES,FENCES,ETC SHOWN 0 THIS DOCUMENT.I HAVE PERSONALLY t I JJ� r MEASU DI TANCE i RTH ON THIS DIE 17 SIGNAT E Z DA a � 1 0 TOWN OF QUE � A L)MIR: BUILDING& D Reviewed B t 3 Betel Date: Hns-�t 1� �1 I/ m AUG 1 0 2006 Tr W ---- --__ _---- 06-240 KAU:I.-my�1, APPROVED BY DRAWN BY A�-.a DATE:W 1 '�ry REVISED .11J f� zd `RONALD S � TpU`I� �L1F�?L� DRAWING NUMBER _ 7 0r-