98-283 BUILDING PERMIT
TOWN OF QUEENSBURY No.
TAX MAP NO . 101 . - 1 - 21 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to GERSTEN r EDWARD
OWNER of property located at 9 DIXON COURT Street, Road or Ave.
in the Town of OueensburI 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 oumnsbury Building and Zoning Ordinance.
'' $DI` ON OURT
QUEENSBURY , NY 12804
2. CONTRACTOR or $LILDERS i'+lamr
SANITARY SEWER
, ,ff&bTl' 9#V `t224
GLENS FALLS NY 12801
A. AarNITPGT'S Name
S. ARCHITECT'S Address
6, TYPE of Construction - (Pww" indicsto by X1 SEPTIC
11 Wood Franca 1 1 MOSOVI I l Steal 11
7. PLANS and Spaclfications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
Nu.
8. Proposed Use
SEPTIC ALTERATION
25 May 27 2000
S PERMIT FEE PAID -- THIS PERMIT EXPIRES 19
ill a longer period is required an application for an axtenaion mu.t be made to In* Building and Zoning inspector of the
tovvn of Oueensbuey before the aKpiration d lei May 19
Dated at the Town of oueensbury this Dayy of 18
SIGNED BY for the Town of Oueensbruy
t3Yildlrlg .�Z- ng inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queeustiury Permit No. -
Dept. of CaW=Mity Development
Building & Codes. Office
742 Bay Road Fee Paid
Queensbury, NY 12804 W74�
--
Location of property for installation:
Property Owner's Name: C f Z-4 6 a or " •e r- ,r;~ eti
Property Owner's Mailing Address: 9 ;Z3
Installer's Name: AN Phone # `7 q1- " 7-Z•A;117
Number of bedrooms (if residential): Total drily flow:
(residential - compute (W ISO gal.Jbdrm,)
Topography: flat, rolling, steels slope 96 of slope
Soil Nature: sand, loam, clay, Other I depth:
Ground water: at whattddepth? feet I Bedrock or Itupervious Material: at what depth? _ feet
Percolation test: required, required [ rate min. per inch j
- - - - - Domestic water supply: Y"" ,�nl�•l pa , well, other
If domestic water supply is a WELL, water supply from any sepdc absorption is feet.
PROPOSED SYSTEM P v c
Septic ffinIc 2b7 goon (minimum size: 1,000 gad.)
Tile field: each trench M _ feet / Total system length feet
Seepage Pits): number of /� f .A ! size eat fL by ft
Size of stone to be used: # 2-- / depth or thickness feet
- - 14OLDING TANK SYSTEM: fif required)
Number of tanks: Size of each: gallons
ALw= rystern and wwociated doclricd work to be mepected by a crorci¢ied ":eW:y
For your protection, please zvA& that parmwt to ,Sectim 136-29 of the Coda of the Taws of Qaeembu Y, nay penlut Or
approval graut»d wtach is based upon or is SmMad in ratumce apace any material xnairreprawaubtion or fi alum to ota]oer a
material fad or known by or ctn behalf of an appticmmt., shall be void.
I have tread the regutabooa wilt► atpplita+�+•+ and choice by tlteae surd all tegttireettet�a of the Town of
Querembury Sanitary Seweaga
Signature of responsible person: Date• ' ' '��"II
TOWN OF QUEENS
BLfRY
BUILDING 8 CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location C
Permit #
( ~ o
SOIL PE. Sand- oam- Clay-
Results of Percolation Test-
( if applicable ) Rate-Minute/ Inch
TYPE OF SYSTEM=
ABSORPTION FIELD: Total L ngt: h
Length of each trench
Depth of trenches _
Size of stone
SEEPAGE PITS : Number- --
Size - ft . x ft .
Stone size
PINING;
Bldg . to Tank ee
Tank to Dist . Sax k
Dist . Box to Field/P ' s.
Openings Sealed ? Ye -"��Ifp artia
LOCATION/SEPARATION!
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPER Y
( ci
Front Rea - Left Side - Right Side
Middle t - Middle Rear
COMMENTS :
SYSTEM USE APPROVED ; YE NO
Arrived:
Depa rted :
Building lnsjpector
MAY 2 7
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# have seen or observed, or bONM f Sm evidence it f all objects such as houses, wells, trees, WCes, ,ete,
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