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2000-816 TOWN OF QUEENSSURY 742 Bay Road, Queensbury, NY 12804-5902 (518) 761 -8201 Community Development - Building & +Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20000816 Application Number: A20000816 Tax Map No: 523400-121-000-0006-059-002-0000 Permission is hereby granted to: QUEENSBURY VILLAGE For property located at: Petrie Ln in the Town of Queensbury, to construct or place at the above location in accordance with application together with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Tyne of Construction Value Owner Address: SAMUEL & VIOLA WAHNON Septic Alteration Residential 39 SARATOGA ROAD GANSEVOORT, NY 12831 Total Value Contractor or Builder's Name / Address Electrical Inspection Agency JOHN VANCE NY Y_ Y. Plans & Specifications 2000-816 SEPTIC SYSTEM TO BE SHARED BY IOTS 20 AND 22 AS PER APPLICATION $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Sunday, October 20, 2002 (If a longer period is required, an application for an extension must be made to the code Enforcement CMncer of the Town of Queensbury before the expiration date.) Dated at the Town ensbu y; Friday, October 20, 2000 SIGNED BY �-f � _for the Town of Queensbury. Director of Building &Aodeeorcement F F i E No . 361 10.-•44 '00 Arl 00 : 13 I D :TO1.,1^J CF r„1I..EEItik:Vs RY FAX:51$ 4,r) 437 pw-E ? ■ Application for Permit . Septic Disposal System .T'0w1! (f QueerrShtlry 74J XIYIlO"df2wee,rr,vbul:Y: NY JJ$04 (516) 761-8256 1 . OWNER INFOAMATION: .._. . , ...4.... . ... . ... . .. .. _...... ... . L.ocatian of uiataliaticr4xLn! �"'�4r f� ///h! �— ... [ilTice iJ y File P*err:it T�a� � „ Tax Map No, 1„� I �„^ ! -�`� '+ •-• r Vwnar'a N a t+E) © Pee PoiJ -- fa Addrsss: 62i4�"IA --+ / Z. INSTALLER'S NAME V ?'i PHONS NO, 3. RESIDENCE INFORMATION: (circle year of dwelling, Indicate # lredrrxrrn(.r) and multiply If 0{ bedrooms with applicable Kcrlfo►rs per bedrrom to equal total dimly flow) X01 lP .ugusl: No of Hedroorna x Cas3ngtttaLign Total L1aiiv Flow 1980 or older x 150 gal/bdnn 4 _ 1980 — 1991 x 130 gatlbdrnti 1991 — present _ x 1 10 gal/bdmi l..J Garbarge Grinder Installed yes J no OCT 2 0 2000 Spa ar Whirlpool Installed yes / no '~ TBUftit7iNi^, ,c EENSSURY ND CC1DE 4. PARCSL INFORMATION, (cirole applicable information & indicate messurement.$) 3tvund Watot.._0g4d Qvk,QrJmPveyiw4Asxetiai_ ' W440r.sillmiy '' xatnrl ___.. rt1 wJ r <1alrlh cr1 wA� hyr1/t tu01.41 k J2olJing rot i ,jo pot �© -- feet „„r. sierp Slops clay ±/'well; writer slops/sp r9f slope other f+•om Orly ,sc1?r►c .r� ercnr depth: absorplten Ix ,,,_,_ __Jl odver Parcolation Test: (robe crrJnplercd ny Jicensed p1 rfc.ralurtaf ertRr, err err nrcltileCt,? —� _ _� Nacre. . minute per Inch 5, PROPOSED SYSTEM: For New C mtrscflen: All itrd#widnal sewage dispesal syslams rnmi be derrigned by a liccn.%W prnfcssieturi cngincerurarvh#tcCl f+iaicso ln!tisllGd in a Mnnnittg flatted a�rn�rd s�+i�Jivi�inn7, Ac14 250 gntlui+4 tea the, si+c of the scptic isntk and Icaelr ficiel for +each Gowbngo + thider, 5r,► or Wltirllxwl '1'o+lr. Septic Tank: �5z� � gallon+ (rhJn. .rfse 1, 0U(J ga1.J Tile Field: each trench f7 Total System Length: Seepage Pit(s): number ref s size rrJ each.* by _ jr Sias ofStons to be used: N Bad Systaon Siz*. Altemtttive Sy'stern: _ length vnwor size 6m HOLDINQ TANK SYSTEM: (if required) Number of tanks: / Site of each: gallons / TOTAL Capacity; gallons Note: Alarm System and associated electrical work must be inspected by a Toners approved electrical inspection agency, ?, SIGNATURE & INFORMATION FOR RESPONSIBLE PERSON (please read) for your protection, lslease note that pursuant to Section 136-29 ortlae Code of tits toms of Quoonsbory, any permit or appmval granted whicix Is baser# lrlxnn or is gralited ill rolianco upon ally snatai"ial nsisrepT"ontation or railuro in iirnko n material fact or circuntstance known by or on beitalroran applicasst, slonII bo void. I have read Use rogulotions with respect to this application and agree to abide by these mold all requirements of the Town OfQueansbury 5asrkary Sewage Disposal Ordinance, -Slgnature of responsible person Date TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 BOY Road Queensbury NY I2W4 (518) 961-8256 SEPTIC DISPOSAL. SYSTEM INSPECTION Name �1 Location LLL Date — 1� L Permit #� SOIL TYPJ: San oam- Clay- Results of Percolation Test. ( if applicable ) Rate-Minute/inch TYPE OF SYSTEM: ABSORPTION FIE D : Total Len h Length of each re Depth of trerych Cj 4a,J� Size of s SEEPAGE PITS : Nurnbor- �+AT Size mvlp, * fte a ft Stone size PIPING : S e — Bldg . to Tank +J I ?�P,�►F Tank to Dist . Box Dist . Box to Field it s + WN Openings Sealed ? es o artial LOCATION/SEPARATIONS: Foundation to Tank t-1I , o 1 t sat Foundation to Absorption eet Separation of Pits et Conforms as per Plot Pi o es o LOCATION OF SYSTEM ON PROPERT { circle one Front ear Left Side - Might Side Middle --Middle Rear COMMENTS . ` C) SYJSTE04 USE APPRO ED : PrC�ES� Arrived- Depa i di spec or eel t IFLpad, 1l DAD4,1 toe f 16 M4. t, 9s-+ 4.5�fr8r ` � � f � �J � r - � L - � >P 1 # j REC OCT 2 0 2000 j } c LANDS OF l raw,, OF f ICON SUILD1 MuFjy FILE COPY r. 9 , t741 1 L �c,a�oDE C1P�lV OF C ~BU . f BUILDING & ASHI & TINA LANDS p PT, F t 1BURN ELSIE OF ETAL r .1 REVIEWED gt�. ' DA EAAT N 1 N MA FY,9