96-659 BUILDING PERMIT .
TOWN OF QUEENSBURY No. 96659
7
TAX MAP N0. 7 . -1-3
VALUE 0 WARREN COUNTY, NEW YORK
.
PERMISSION is hereby granted to RHLERS , ROLE & LUISE
Street,Road or Ave.
OWNER of property located at 105 KNOX RD.
in the Town of Queensbury,To Construct or place a 'EPTIC ALTERATION
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
3 ACADEMY RD.
ALEANY, NY 12203
2. CONTRACTOR or BUILDERS Name
C t DA I�, CIIP,IC
3. C N't A O or BUILDER S Address
R.D . #1 , BOX 1376
LAKE CEORCE , NEW YORK 12345
4. ARCHITECTS Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( 1 Masonry ( )Stee
1SEVIIC
7. PLANS and Specifications
No.
septic alteration as per plot plan specifications
8. Proposed Use
SEPTIC ALTERATION
$ 29 PERMIT FEE PAID —THIS PERMIT EXPIRES October 22 ,19 98
(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.)
Dated at the Town of Quee y • 22 Day of October 19 96
/ -.or-
SIGNED BY for the Town of Queensbury
Building and Toning Inspector
Application r plication fin- SEPTICDISPOSAL o
• STAMP RECEIVED
Vl?1)
I.ocaliott of property for installation: ,iv C�'1, 6/7 0
e'� i JO�
�j A-Ss ( a&q Pt2/'4 (i�t
Owner's Name, AO L- ,} 0 Z- S I' ttM1.1'NUM11ER
Owner's Mailing Address: _ C�� C,-.(zprr
taefluct(//r1 oal 20 rd
8_3 2
n FEE PAID •
Installer's Name:61#4 /S C/d. 0 /1 Phone #:11 S 3• c '-1
Number of bedrooms (if residential): .
Total daily!low (residential.-compute w 150 gal. per bedroom): 4570
Topography: Flat . - 1-1 Rolling r1 Steep Slope 35 of Slope
Soil Nature: n Sand n Loam F-1 clay I1 Other /Depth:
--------_" •=::'cam=Atie,1,9
Ground Water: at what depth? feet
�, 6Bedrock or Impervious Material: at what depth'? (eel on 2�� I99
c.Jrcolalion'I'csC' • i Not Required Q Required/Rate min. per inch,
.�,,. I Domestic Water Supply: 0 Municipal 1-1 Well rI Other
If domestic water supply is a WELL: water supply from any septic absorption is feet
P f. A k) T'd fatpZ JG�
PROPOSED SYSTEM: .'
Septic tank; IfOOO gal, (minimum size: 1.(l(l(l gal.) /
'lilt Field: each trench feet. / total system length feet.
Seepage Pit(s): number of / size each: • ft.z ft.
•
Size of stone to be used: # / depth or thickness feet- •
IIOLIDING TANK SYSTEM: (if required) •
•
• Number of tanks: NO.)&-: Size of each: gal.
lL Alarm system and associated electrical work to he inspected by a certified agency.
For your protection,. please note that pursuant to Section 136-29 of the Code of the Town of
Qucenshury, any permit or approval granted which is leased upon or is granted in reliance upon .
•
any material ntisrepfeset:tation or failure to make a material Pet 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 Ordinance.
Signature ofrespottsili'e person: . Date:
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804 VAN4
(518) 761-8256 rio reu
SEPTIC DISPOSAL SYSTEM INSPECTION I_
Name
Location
Date 1 6 )� Permit #
(PC°)
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total - gth
Length of each. -nch
Depth of trenches
Size of stone
SEEPAGE PITS: 'umber-
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 P1 an Yes No
LOCATION OF SYSTEM ON PROPERTY: .
(circle one)
Front - Rear - Left Side Right Side
Middle Front - Middle Rear
COMMENTS:
f/ O.R. .sYdritr et C f/G
SYSTEM USE APPROVED: YES NO
Arrived: q'(.i?
Departed:
of
Building Inspector
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