98-164 Elm
ert
Cni-cateCJCO �l �) �.lc�.nce
Town of Queensbury
Warren County, New YOM
April 24 98
alsipocertify that w 98164
� work requested to be done as shown by Permit No.
has been completed.
SEPTIC ALTERATION
This structure may be uused as a _ it
MACEY , PRANK & SUSAN
owner
"TAX MAP NO * 7 2 . - 6 -- 2 1 *By Order Town Board
TO VPt*4 QLIEENSBU A y
Director of Building Cade l';nfarce went
BUILDING PERMIT
VALUE S 0 TOWN OF QUEENSBURY No. 98164
TAX MAP NO . 72 . — 6- 21 WARREN COUNTY. NEW YORK
PERMISSION is hereby granted to SUSAN
OWNER of property located at 17 A1i'IATION RD • 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 Queensbury Building and Zoning Ordinance.
t. OWNER'S Address is
17 AVIATION RD .
QUEENSBURY , NY 12804
2. CONTRACTOR or BUILt7ER'S Name
SANITARY SEWER
3. CONTRACTOR or BUILDER'S Address
DAN DRELLOS PO BOX. 224
GLENS FALLS NY 12801
4. ARCH(TECT'S Name
5. ARCHITECT'S Address
G. TYPE or Construction — (ptesse indicate by X) SEPTIC
I ) Woad Frame I I Masonry I I Steel I I
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT FLAN SPECIFICATIONS
a. Proposed use
SEPTIC ALTERATION
April 21 2000
$ 25PERMIT FEE PAID — THIS PERMIT EXPIRES 1$
I I f a longer period is required an application for an extension must be made to the au lid ing and Zoning inspector of the
town of OueensburV before the expiration date.F
21 Apr i 1 3. 9
Dated at the Town of Queenssb`u`rry.,t�his Day of 19
SIGNED BY h. for the Town of 0ueensbury
Building I Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Qwerasbnry P CT '} / L
Permit Na.
Dept. of Commuuaity Developwent w�tf� /
Building & Codes Office ,APR 21 9W p t�
742 Bay Road _ y. Fee Paid $
Queensbury, NY 12W4
Location of property far installation: ' Q LC) A �fi
Property Owner's Name: cJ V .ram N MAC, e y
Property Owner's Mailing Address: r :2 Q Q d cC l +'�"i rJ.✓
Installer's Name: Phone ,
Number of bedrooms (if residential): Total daily flow:
(residential - compute 0 150 gal.Jbdrns.)
Topography: Sat. rolling, steep slope % of slope
Soil Nature: sand, loam, clay, other I depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? ____ feet
Percolation rest: -- not required, required [ rate min. per inch ]
Domestic water supply: .�L4 municipal, wel19 other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
septic tank: gallon (minimum size: 1 ,000 gaL)
Tulle field: each trench. S feet I Tonal system Iengtb o'2 aZ) feet
Seepage pit(s): number of ! size each: ft. by ilt.
Sire of shone to be used: # - / deppth or dtickness _,..,Z feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons.
Ala= system and aswomed aectdi wW x to ba inspected by a owtzGed Meocy.
For your proteodou„ please noes that pursuant w Secd n 136-29 of this coda of tbo Tacvn of Quamebmy. our pawmit Or
approval gamed which is beard upon oc is granted is xelianc+e upon any nuderiel 0offlubdion or failure to mft" a
wateaial fret or cirounistwmas known by or on behalf of aid .:lice; shalt be void.
I have need the m8uLbons with agppiicatmn and agree to abide by thane and all requivemnatm of the Town of
Queeasbury Ssurtaxy SOWS6eD"yc
Signature of responsible person: A 2e, Date
i
` TOWN OF QUEENSBURY
BUILDING 1I CODE EMFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-9256
SEPTIC DISPOSAL SYSTEM INSPECTION
I
Name 11 G-\
Location [ I
Date L4 7vA9�b Permit # —
SOIL TYPE : Sand- Loam-Clay-
Resul s of Percolation Test.
( if a livable ) Rate-Minute/ Inch
TYPE O SYSTEM:
ABSORPT ON FILL Total Length
Length o each re h
Depth of enc s
Size of sto e
SEEPAGE PITS . umbe
Size - t . x f t .
Stone size
PIPING; Size ype
Bldg . to Tank 14
Tank to Dist . Box 1~
Dist . Sox to Field it Lt
Openings Sealed ? artia
LOCATIONISEPARA .
Foundation to Tank _V2,�r feet
Foundation to Absorption �--r feet
Separation of Pits _ feet
Conforms as per Plot Plan
LOCATION OF SYSTEM ON PROPERTY
( circle one )
Front - Rear - Left Side - Right Side
Middle Fro n a ear
COMMENTS :
SYSTEM USE APPROVED = YES
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Arri►red
Depart
ui ing Inssfedtor
APR 21
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'OWN OF qU
ay
3 e"1 �r
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"! I�wsrrlf f6mkIK W won f aw hove or observed, or believe i saw evrHory nJ�
MoL + . alr obje such as houses, wQlls #r{ s
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