98-353 BUILDING PERMIT
VALUE $ la TOWN OF QUEENSBURY No 98353
TAX MAP NO. 110. —1-2.3 WARREN COUNTY, NEW PORK
PERMISSION is hereby granted to COMMUNITY WORKSHOP, INC
OWNER of property located at 690 QUAKER RD. Street,Road or Ave.
in the Town of Oueensbury,To Construct or place a SEPTIC ALTERATTON
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
P.O. BOX 771
GLENS FALLS,NY 12801
2. CONTRACTOR or BUILDER'S Name
I.B.S. SEPTIC
3. CONTRACTOR or BUILDER'S Address
2 LOWER WARREN STREET
QUEENSBURY, NY 12804
4. ARCHITECT'S Name
6. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( )Masonry ( 1 Steel ( 1
7. PLANS and Specifications
SEPTU ALTERATION AS PER PLOT PLAN SPECIFCIATIONS
8. Proposed Use
SEPTIC ALTERATION
25 June 19 2000
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date.)
19 June 1998
Dated at the Town of Queensbury this Day of 19
SIGNED BY 1� L .l for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury C
Dept. of Community Development Permit No. ()E,-3 _
Building &Codes Office �:;'-• ti;, m•; �" o
742 Bay Road ° "« :t _ Fee Paid $ ,
Queensbury, NY 12804
JUN - 81998 J
Location of property for installation:- -_-- : "i.?'`- c&ve (1 6
Property Owner's Name: ( W ,
Property Owner's Mailing Address:
Installer's Name: ,A, c. J,',Q>1 , Phone # ),7f -1 9 V
Number of bedrooms (if residential): Total daily flow:
(residential - compute @ 150 gal./bdrm.)
Topography: Vflat, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other/depth:
Ground water: at what depth? Vet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: /V 4—not required, required [late min. per inch]
Domestic water supply: Kmunicipal, well, other
If domestic water supply is a WELL, water supply from any seudc absorption is feet. "
PROPOSED SYSTEM
Septic tank/6O d gallon (minimum size: 1,000 gal.)
, ,`` Tile field: each trench feet / Total stem length: feet
Seepage pit(s): number of / size each: r ft. by Cir ft.
Size of stone to be used: # ) / depth or Thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each gallons
CAI&m 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 misrepresentation or failure to make a
material fact or circumstance known 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 Ordinatece 3. / V `7 �2(
Signature of responsible perso Date:
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TOLE OF QUEENSBURY
BUILDING G CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM sPECT
(::: .. 3
fi .� qg
Name �,;( • S
Location '7f�5'� iU�4�' --- ---`/
Date 3/4145 Permit # PG-NOWCO
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. 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 feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM 01 PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
5 ire Cik.K. Fd2 'r5'3r-Im.
16vt,J I - 3-1 t& )C 2-5
SYSTEM USE APPROVED: YES NO
Arrived: ____i:_eb
Departed:
--fe
Building Inspector
r--
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518)761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date a/9 Permit #
SOIL TYPE' Sand)Lo - lay-
Results of Per of ' n Test-
(if applicable) R te-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each tre ch
Depth of trenches
.Size of stone
SEEPAGE P T.; Numb r-
Size - ft. ft.
Stone size . -C
PIPING: Size Type
Bldg. to Tank d� �2
Tank to Dist. Box `0
Dist. Box to Field/PI et {
Openings Sealed? Yes No Partial
LOCATION/SEPARATION
Foundation to Tank /L feet
L�.4Foundati on to Absorption / feet
Separation of Pits feet
Conforms as per Plot Plan (Yes No
LOCATION OF SYSTEM ON PROPER :
(circle ,
Front - ear = Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: HO
Arrived:
Departed:
Building Inspector