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2002-037 TOWN OF QUEENSBURY 742 Bay Road;Queensbusy,NY 12804-5902 (518)761-8201 Community Development-Building& Codes (518)76168256 BUILDING PERMIT Permit Number:. P20020037 Application Number: A20020037 Tax Map No: 523400-309-015-0001-063-000-0000 Permission is hereby granted.to: WILLIAM R. BREEN For property located at. 45 RICHARDSON, St in the Town of Queensbury, to constructor place at the above location in accordance with application together with plot plans and either information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Twe of Construction Value Owner Address: JAMES & KAREN LOCKHART Septic Alteration Residential 45 RICHARI)SON St Total Value QUEENSBURY,NY 12804 Contractor or"Builder's Name/ Address Electrical Inspection Agency I.B.S. SEPTIC 2 LOWER WARREN STREET QUEENSBURY.NY Plans,&Specifications 2002-037 WILLIAM BREEN SEPTIC ALTERATION AS I ER APPLICATION $25.00 ' PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,January 17,2003 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of QueNurqyfore the expiration date.)Dated at the T we ; u January 17,2002 SIGNED BY for the Town'of Queensbury. Director of Building&Code Enforcement Application for Permit—Septic Disposal System ' 'V -. Town of Queeitsbuty-74?1Tay Riurd Queensbtiry,NY 12804-018} 761-8256 1. OWNER INFORMATION:. JAM_ I q 2002 .... ........ ...... .... Locadoh of installation: � /t r�:- , � o �-O 'q9t' EEN.....U S BUlI!J!Nue AP�liJ _,DE .. File Penn Tax Map'No;"� / / Permit g \ ,00/�VA R X) Fee Paid Owner's Name[: i L'c_ Tl�s .. Address:_ / q6�. 2. INSTALLER'S NAME _ ? - -f'C / PHONE NO. 3. RESIDENCE INFORMATION:- (circleyear'of dwelling, indicate#bedroom(s)and multiply H qJ bedrooms with applicable gallons per bedroom to equal lolal daily flow) Year of House:. No of Bedrooms x Colnptitation Total Daily Flow - 1980 or older _ x 150 gal/bdrm = S~G? y C 1980— 1991 x 130 gal/bdrm 1991 —present x .. 110,gallbdrm Garbage Grinder Installed yes___ /.no Spa or Whirlpool Installed yes l..no . 4. PARCEL INFORMATION: (circle applicable information do indicate measurements) tSl_t9 - Q.�Ou_�41 tttRr_ _DS?51roC or�InppC1'Lgt!$ �tQriall`r�oms)Sl Water$titjrj�ly k 1Yat rand crJ w1 cu etrllr ni-u�lr t rlrtlr a►rlcrt rl Rolling c alit eet - "feet _ sve/I Steep'slope'. clay /� -t! = if►veil;'tvater stq;p1y Y slope other from any septic-system" depth: absorption is f). other Percolation Tea, o be completed by licensed prt fessivnal eng'Ineer or architect} Rate: nrinute per!Itch - 5, PROPOSED-SYSTEM For.New Construction: All individual sewage disp osal peso! systems Hoist be designed by n licensed professional engineer or architect(unless instailed in a l laiin' g t3oard al�irttved sulxfivision). ;Acicl 250 g.ilions Iv the size of(11e septic lank and leach field for cack Garbage(Mvider, Spa or Whirlpool Tub'." Septic Tank: -IZAQ_gallon_(min. size 1,000 gal) Tile Field: .each trench�fl, Totitl System length: Seepage Pit(s): .number rrf size of each: . jl. by Jl; Size of.Stotteto be used: ll / du/rth'vr thlckrie.vs,.____ -feet Bed System size: 'x Alternative System: length and/or size 6, HOLDING TANK.SYSTEM: (if required) Nunnberoftanks: J Size of each: gallons_-/TOTAL Capacity _Note: Alarm,System and,associated:electrical work must be inspected by a Town approved electrical inspection-agency. 7. SIGNATURE, &INFORMATION FOR RESPONSIBLE PERSON(please read) For your prat©ctiori;.ptease note.that pursuant to Section 13649 of the Code ofthe Town- a£Queensbury,.any perinit-or approval granted which is:based_npoh or is'granted in rotiance'ttpon any material misrepresentation or_taitnre to makes material fact or circumstance knowir by or on behalrof an applicant, shall be void. I have tend the regulations with respect to this application and agree to abide by those and all= requirements of the Towt of Queensbury Saititaty Sewage Disposal Ordinance. 8 gnature of re6ponsil5le person Date . cc �.� '. TO OF QUEE RY BUILDING--AMA-;oDM , I .r , . _BY_ I RE—�IE - -ED i DACE - t i 1-have-wen en-for-obserued.or-believe-II-saw evidenc e o , — ali-abject -such_as_houses,wells,trees,fences, etc., I s,howh a this document. I also represent had I have r� 'Hall measured the distances set f�rm oche diagram." — pe s� _ D SIGNATURE __ +1iE t —_ __ ____ v...•9.1Y�„ I S 5 3:v/pGi:nL � tt � c ±C{ 5�4t�S+��i {"2Y$ 3`v ��uf �r,fil;f,a3 9..`�s Et i� Sti3b a:7Gu '•.Sf`l�'11Ei77a G=.`"J fF f i P.34 G • k isi Ai ?s i ate a Jl4Y_'k_s.r . �+. .--�tip.:�.i:u"` '�'.. �,•� � '"., v I tl 10