2000-377 • 7
(,er
Com1'4' 11a""1"0'*,flCe
Town ofQueensbury
Warren County,New York
Date Jung 1 0 2000o
This is to Corti y that work requested to be done as shown by Permit No.
has been completed,
`This structure may be used as a SEPTIC ALTERATION
I WESTNORE AVE.
Location
Owner� � LE FORTE, GEORGE & E. ., ,.�
TAX MAR NO, 81 a-7 y Order Town Boar.
TOWN OF QUEENSBURY
ec opt~ .. Ong, bode Enforcement
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 0 Building Permit'No. 2000377
TAX MAP NO. 81 . -7-9
Permission is hereby granted to LE .FORTE, GEORGE E.
Owner of property located at 1 WESTMORE AVE.
in the Town of Queensbury,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 NYS,Uniform Building Codes and the Queensbuty Zoning Ordinance.
Owner's Address:
CAROLE 1 WESTMORE AVE.
QUEENSBURY, NY 12804
Contractor or,Builder's Name:
HOWARD, DAVID
Contractor or Builder's Address:
Electrical Inspection Agency:
Type of Construction:
SEPTIC...
Plans and Specifications:
. SEPTIC ALTERATION.AS PER PLOT. PLAN SPECIFICATIONS
Proposed Use:
SEPTIC ALTERATION
25 May 26 2002 .
$ PERMIT PEE PAID—THIS PERMIT EXPIRES
(If a longer period is required,an application for an extension must be made to the Code Enforcement
Officer of the Town of Queensbury before the expiration date.)
T of Queensbury thi 2.. Day of May 2000
'
for the Town of Queensbury
Code Enforcement Officer
Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Location of installation: Office Use
File Permit No
Tax Map No.
Owner's Name: -Z-a,1, Fee Paid
.......... .............. .......... ...............................................
Address:
2. INSTALLER'S NAME
PHONE NO. 2 YA 9-2,
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation Total Daily Flow
C44j"d::e:r:-:) x 150 gallbdrin
1980- 1991 x 130 galfbdrm
1991 -present x 110 galfbdrm = RFIC1,GIVED
Garbage Grinder Installed yes no MAY 3 0 2000
Spa or Whirlpool Installed yes_ no ToWN OF QUEENSBURy
BUILDING.,P 4 D C 0 D i
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Twography Soil Nature Ground Water Bedrock or IMervious Material Dom stic Water Supply
<�s�an at what depth at what depth municipal
Rolling loam feet feet well
Steep slope clay if well;water supply
%slo -T
slope other from any septic-system
depth: absorption is_ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed
professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: 1610-j?,, gallon (min. size 1,000 gal.) — 1
5 3 It-.
Tile Field: each trench ;2- Total System Length: -L-t---ram--ft.
Seepage Pit(s): number of size of each: ft. by
Size of Stone to be used: # depth or thickness feet
Bed System Size: X
Alternative System: length and/or size -5-3 kt I^J'l Kvuk.%-
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons /TOTAL Capacity: _gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
I electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
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 Ordinance.
'gignature of responsible person Date
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show NORTH arrow _
2000377
81.—7—9 1P ��• � T a.�----_—_
LE FORTE, GEORGE & E. MAY 3 0 2000
1 WESTMORE AVE.
)l "r 5 `✓.
SEPTN N,TERATIOId
_ W TOWN OF QU ENSg RY
Q ..
BUILDING�c ?
REVIEWED By Q
DATE
TOWN OF
� ��EEN 9U1
m . p on r tD1NG DEF"RTM
/ ' mfh our enunaPbn�fttud ENT
P oa Wans and .O'lehall
y /J r r�v �maiancn with Phheet'6ea�n lu#
0. c 1��: j
p[u� _ FILE:COPY
SG i T "I hav e" rved,or believe I saw evidence of,
10
all o s ch as houses,wells,trees,fences,etc.,
show o is document.I also represent that I have Z
Personally measured the distances set forth on the,diagram." -Q
SIGNATURE W
4
SIGN DATE a U
_. Z 0
FOR THE PURPOSE
0 SCALE:LE:10 feet OA := r` feet
squaresquare
OF AN APPLICATION TO THE.
1"Own Of I�ueenSburv, ON LEFT
- OR CREATE YOUR OWN. 7,
Warren Count, New OrK CHOOSE SCALE 1 inch or 4 squares =,40 feet inct5 or_squares —feet - -