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98-758 • • • BUILDING PERMIT .. . "0 TOWN OF QUEENSBURY VALUE $ No. . q R 7 Rs. : TAX. MAP NO. 101 . —5-12 WARREN:,COUNTY, NEW YORK PERMISSION is hereby granted to -" WARREN—WASHINGTON ARC OWNER of property located at 22 JEROME AVE. Street.Road or Ave. in the Town of Oueensbury,To Construct or place a SEPTIC 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 Oueensbury.Building and Zoning Ordinance. 1. OWNER'S Address is 79 GLENWOOD AVE. QUEENSBURY, •NY:, ..12804.::,_. 2. CONTRACTOR or BUILDER'S Name • . I .B. S. SEPTIC 3. CONTRACTOR or BUILDERS Address 2. LOWER WARREN STREET QUEENSBURY,:,NY :.:. 12804 4. ARCHITECT'S.Name 5. ARCHITECTS Address 6. TYPE of.Construction—(Please indicate by Xi SEPTIC 1 1 Wood Frame ( I Masonry ( Steel 1 1 7. PLANS and Specifications No: 8. Proposed Use SEPTIC ALTERATION $ PERMIT FEE PAID —THIS PERMIT,:EXPIRES 19 Cif 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.) " 10 December , 1998 Dated at the Town of Queensbury this Day of 19 SIGNED BY for the Town of Oueensbury Bui nga Zo ing lnt ectOf I: , Application for SEPTIC DISPOSAL PERMIT r Town of Queensbury Dept. of Community Development Permit No. ( � �4 Building &Codes Office �� 742 Bay Road Fee Paid Queensbury, NY 12804 ~ J -44 Location of property for installation: )--cam ,/C r a /�•C cA,L. c-. _ . / Property Owner's Name: (4",),r r C"• (..... -- '4 A 2, C ° O j1999 Property Owner's Mailing Address: 6'4 LA, 4., c- ._-v____` -��= M Gq Installer's Name: ,,Tc 8, c. S,p7 f G Phone # ) 9T pl 9 LI q - 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?A f t / Bedrock or Impervious Material: at what depth? _ feet Percolation test: /fnot required, required [rate min. per inch] Domestic water supply: )(municipal, well, other If domestic water supply is a WELL, water supply from any septic absorption is feet. _ PROPOSED SYSTEM L 6%-.5t iftjrAcio% i',t-c- 7'c 0 it 6 Septic tank/t OJ gallon (minimum size: 1,000 gal.) Tile field: each trench ! b _ feet / Total system length: D©6 feet Seepage pit(s): number of / size each: . ft. by ft. Size of stone to be used: #_,21.___ / depth or thickness feet - HOLDING TANK SYSTEM: (if required) Number of tanks: i Size of each: gallons `Alarm system and associated electrical Rork 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 belwlf 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 Sianature of responsible person: Date:�� L / --Y j . s / OFI1IVn TOWN OF QUEENSBURY Oy- BUILDING & CODE ENFORCEMENT � � 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name7\4.-Ar--\\, \-\‘(14-01— -Ng Location ( ) Date a 1)913 Permit # C:1R--),jg SOIL TYP : Sand-Loa - lay- Results of Percolation Te t- (if applicable) Rate-Minut /Inch TYPE OF SYSTEM: 5 ABSORPTION FIELD: Total Len Length of each trench I , • Depth of trenches '- 1 Size of stone 1 SEEPAGE PITS: N mu ber- Size - ft\ x I ft. Stone size \ PIPING: \ S ;ze Type� Bldg. to Tank 5t,,q g5 Tank to Dist. Box /'-' ' v go Dist. Box to Field/Pt, i/ :i Openings Sealed? s No Partial LOCATION/SEPARATIONS: Foundation to Tank /1) feet Foundation to Absorptio ,.li feet Separation of Pits eet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON,'PRO'' R (circle one) ' Front - Rear - Left-/S-':e - 'ight Side Middle Front - - ' - . - COMMENTS: • /• SYSTEM USE APPROVED: YES NO Arrived: ;_ Departed: • de.(1 Building Inspector ' i - _ it — .-,;,►� --iDAi0,U d l 1 �1 E■EEE■■E:i':: ::im'::E Ei: :■■i• 'E 1.9111111': ' • -__ - - - E EE II E� 'iIIipUiII:1■■ ■M■■ ■ ■■ ■ ■ ■E■ . ■ ■ ■ M■■■ ■■■E -- ---- _ ■. ■. :■■:E- ■C ■. E■. ■E. ■■EE.. : ■H■■:■_ - ' J .:■M -': ::::: - ::1:::• ::.■::: : 5��-Lf {---1 --I_ _ --� - - - :E■. EE■_':" " T: :C EE...M.. MOEEC _, --- ....E ..... .CE"'E: ::�. . CI"C:EE:H :C.. '. -'° rl I 111111H1 "=WM . �1001_ II 1_ 111 ::: :: : ■ - i "_- ■MM■MM■MM■■MME ■■■■■EiiiIi ■EEE■ ■■ ■M W iEEII' '' -.-- ,w,�►, , ;_ :7_ - ---:' I . _ .1 .. 1 '::IiFllF! 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