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98-560 BUILDING PERMIT VALUE $ TOWN OF QUEENSBURY Ala, � 8L56{A TAX MAP NO . 74 . - 1 - 26 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to RAYNQR Tt'ENNETH A Er TSIE_ OWNER of property located at 1079 WEST Street. Road or Ave. in the Town of OueensburY. To Construct or place a 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. OWMER'S Address is 1079 WEST MT ., RDII, QUEENSHURYr NY 12804 2. CONTRACTOR or SUI LDER`S Name QUEENSSURY SEWER 3, CONTRACTOR or SUiLDER'S Address JAY SWEET 0 4. ARCHITECT'S Name S. ARCHITECTS Address S. TYPE of Construction — tPlesse indicate by x} SEPTIC I I Woad Frame I ) masonry ( 1 Staei t } 7. PLANS and S eclfications SEPXIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS S. Proposed Use SEPTIC ALTERATION 2 11 5 September 10 2000 $ PERMIT FEE PAID — THIS PE14MIT EXPIRES . 19 (If a longer period is required an application for an extension moat be mad@ to the Budding and Zoning inspI of the town of QueensMury Fore the expiration date,} 10 September 1998 Dated at the Town of Queenoury this _ Day of 19 SIGNED BY for the Town of Queensbury Building and Zoniry} Inspacxar Application for SEPTIC DISPOSAL PERMIT Town of Qaeeosbury ^I Permit No. Dept. of Community Development D Building & Codes Office r'] o 742 Bay Road Fee Paid $ tnA� w Queensbury, NY 12804 r-� Location of property for installation: / � ` 4 tkd� .�S i yh* Property Owner's Name: _ L< e Vti LCA. lrf ►'1 ic) r" Property Owner's Mailing Address: P,_� Installer's Narne: JQ 0- v' Phone # Number of bedrooms (if residential): Total daily flow: (residential - compute Qa 150 gal./bdrm .) Topography: k, fiat, rolling, steep slope To of slope SE P 6 (71998 Soil Nature: ^, sand, loam, clay, other 1 depth: Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet Percolation test: .>L not required, required [ rate min. per inch ] Domestic water supply: >C municipal, wen, other If domestic water supply is a WELL, water supply from any septic absorption is feet, PROPOSED SYSTETu����� Septic tank: gallon (nuturnum size: I ,000 .al.) Tile field, each trench feet / Total system length: feet Seepage pit(s): number of �?_^ 1 size each: ft lay t D ft. Size of stone to be used: # I depth or lzickriess 2, feet HOLDING TANK SYSTEM: (if required) Number of tanks: Size of each: gallons AIarut system abd associated electrical wnrk to be jasp * by a certified agency. For your protection, please note that pursuant to Section 136-29 of the Code of the Town. of Qaeensbary, any permit or approval granted which is based upon or is granted in reliance upon any ataterial misxelareseut'60n or fmausa to mace a material fact or cj=awstance known by or on behalf of an applicant, shall be void. I have read the regulations with rewect to this application and agrees to abide by these and all rvquuv eats of the Town of Queernsbury Sanitary Sewage Dialwsal 0113i0a"Ca. Signature of responsible person: . Date: S 4f / !1 TOWN OF QUEENSBURY BUILDING A CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION Name Location 79` Al, Date Q Permi t SOIL 7YP an Loam- Clay- Results of Percolat on Te ( if applicable ) Rate Minu e/ I ch TYPE OF SYSTEMI ABSORPTION FIELD : Tota L ng Length of each trench Depth of trenches Size of stone SEEPAGE PIg Number- Size - ft � ft . Stone size ,� PIPING . ize Bldg . to Tank Tank to Dist . Box .ci ¢ Dist . Box to Field/ Openings Sealed? Yes No a�t a LOCATION/SEPARATi Foundation to Tank feet Foundation to Absorption feet Separation of Pits feet Conforms as per Plot Plan es No ION OF SYSTEM - ON PROPERTY c c one ) Fro - Rear - Left Side - Right Side i dl a Front -- Middle Rear COMMENTS : SYSTEM USE APPROVED : YES NO Arrived : Departed : ,• Building Inspector SEP /0 J998 c,c4..j ez ty HLE COPY how 2"" or dMMp"A all ob** $M* la Ow" Oft thig a y NL TOWN OF Bull TOWN OF QUEENSSURy BUILDING DEPM ENT Based on Our limited exami"atkM, DATE compliance with our comments Mall not be construed as indicating the Plans and specifications are in f4j[l Compliance With the code. 42