97-740 BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 97740
TAX HAP NO. 48.-3-50. 2 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to BRITTO>lt S t EPRtEN 6t L^RI
OWNER of property located at 92 TEE HILL RD_ Street, Road or Ave.
in the Town of Oueensbury,To Construct or place a glePq r-C ALTERATZoij
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.
I. OWNER'S Address is
92 TEE HILL RD.
QUEENSBURY,, NY - 12804
2. CONTRACTOR or BUILDER'S Name
ig.:,,-BTEPHHN
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC.
1 1 Wood Frame ( 1 Masonry ( )Steel 1 1
7. PLANS and Specifications
BEPT'lIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
iftiviitt December. 18 99
$ 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 Queensbury before the expiration date.)
18 December _ - 92
Dated at the Town of Oueensbury this_ Day of 19
SIGNED BY6 A,'C..' — 01 for the Town of Oueensbury
Building and Zoning Inspects
Application for SEPTIC DISPOSAL PERMIT
Town of QnPpnsbury Permit No. 67--)_ / C+
Dept. of Community Development
Building &Codes Office
742 Bay Road Fee Paid $
Queensbury, NY 12804
Location of property for installation: .4)
Property Owner's Name: a/0/7/1/1/- DEC 1 8 1991
Property Owner's Mailing Address: / 'f
Installer's Name: 57,4147 fi Phone # / 3_ 55/O
Number of bedrooms (if residential): Total daily flow:
(residential - compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other /depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: not required, required [rate min. per inch ]
Domestic water supply: municipal, y well, other
If domestic water supply is a WELL, water supply from any septic absorption is glP feet.
PROPOSED SYSTEM
Septic tank: (ii#
gallon (minimum size: 1,000 gal.)
Tile field: each trench feet / Total system length: feet
Seepage pit(s): number of I / size each: ft. by 0 ft.
Size of stone to be used: # / depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
1
Alarm system and associated electrical work to be inspected by a certified agency.J
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 bide . ese and all requirements of the Town of
Queensbury Sanitary Sewage Disposal •t•-. /
Signature of responsible person: er Date:
/2/ /1-17
TOWN \),-)
OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
sThr\ ) --e10\--tc‘,
Location }L�. (Z
Date J ,--).c1 I7Permit # 7-711D
SOIL TYPE: San -Loa lay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: ,gym
ABSORPTION', FIEI,.b: Total Length
Length of efcty trench
Depth of tre thes
Size of stop
SEEPAGE PIT : umber- /
Size - ft. x - ft.
Stone size
PIPING: Size Type
Bldg. to Tank .f''
Tank to Dist. Box / --
Di st. Box to Field/Pit =_ ,fL.
Openings Sealed? ems) No Partial
LOCATION/SEPARATIONS:
Foundation to Tank a feet
Foundation to Absorption —''r- feet
Separation of Pits a feet
Conforms as per Plot Plan es No
LOCATION OF SYSTEM ON PROPERTY''
(circle one)
Front - Rear - Left Side - Right Sic�.e
Middle Front - Middle Rear
COMMENTS:
6;;�11 %o . �� l 7717")
SYSTEM USE APPROVED: YES'' NO
Arrived: -,
Departed:
Building Inspector
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