98-594 TOWN OF +gU£ ENSSURY
WARREN COUNTY , NEW YORK
( � Date September 22 19 98
98594
This is to certify that work requested to be done as shown by Permit No . _
has been completed .
sE.Pmlc ALTERATION
This structure may be used as a — .-
11 PINEWOOD RD .
Location —,
SIMIONE , DOMINIC & ELMA
Owner
TAX MAP NO . 126 . -- 1 - 23 By Order of Town Board
TOWN OF QU ENS URY
Director of Building !G Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBUR.Y No. 98594
TAX MAP NO . 125 . - 1 - 23 'WARREN COUNTY. NEW YORK
PERMISSION is hereby granted to SIMIONE , DOMINIC & ELMA
11 PINEWOOD RD . Street, Road or Ave.
OWNER of property located at
in the Town of aueensbury, To Construct or plans a SEPTIC ALTERATION
at the above location in accordance to application together with plat plans and other information hereto filed and
and Zoning Ordinance.
approved Cl
and in compliance with the Town of ueensbury Building
r
dress is
INEWOOD RDM
NSEURY , NY 128{04
OR or BUiLiDER S NormaON SEPTIC & DRAIN SERVICE
OR at BUILQERS Address
Jill
4. ARCHiTECT"S Name
6. ARCHITECT'S Address
6. TYPE of Construction — (Please indicate by X) SEPTIC
( } Wood Frame ( I Masonry 1 } $teal f }
7_ PLANS ands cificstians
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
September 21 2000
25
S PERMIT FEE PAID — THIS PERMIT EXPIRES
19
(it ton eir o 4riod i wryuired a to expoiretion date Ixtension must be made to the Building and Zoning impel of the
town 21 September 1998
Dated at the Town of C}ueensbury this
D y of i9
for the Town of Oueensbury
SIGNED BY Buie end Zonirvg Irtsp+tctM
r A,ppiieation for SEPTIC DISPOSAL. PERMIT
Town of Queensbury Permit Nov� r-
Dept. of Community Development _
Building & Codes Office '
742 Bay Road Fee Paid $ � —
Queensbury, NY 12804
Location of property for installation:
,,,
on:
Property Owner's Name 7491AJ 4( �''i 'j f e45 fiI
Property Owner's j1 ailing Address: r' '
/ C
Installer's Name: "CSr N j .v . G �+l l�/or1.S;. :- W Phone #
Number of bedrooms (if residential): Total daily flow: o
(residential - compute 0 150 gal.lbdrm.)
Topography: flat, rolling, steep slope % of slope
Soil Mature: sand, loam, clay, other f depth:
Ground water: at what depth? feet 1 Bedrock or Impervious Material: at what depth? feet
Percolation test: _ not requi . required [ rate min.- per inch �
Domestic water supply: Xmunicipal, well., other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM �^ 3����
Septic tank.: Q� b*allo`titninimum size: 1 ,000 gal.)
Tile field: each trench feet / Total system length.: 2-1 0 feet
Seepage pit(s): number of l size cacti: ft- by ft,
Size of stone to be used: depth or tbLickness ! ✓'r feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each- gallons
Alarm system and asacxiated electrical work to be jw ---a by a oerrtifl armor-y-
For your protection, please now that pt n axd to Section 136-29 of the Code of the Town of Que"bu y, any Peru or
approval granted which is based upon or is granted in rebemce upon any material miarepreseEtstion or faure to make a
material fact or cir%,n tanc-e ]mown by or on behalf of am r =zt, abatl be void,
1 have read the regulatiow with respect to this applicatfan And agree to abide by these and all requavymeuta of the Town Off
Queensberry Sassitary Sewage l7Isposal fie- ,/�.-- y --�,J
Signature of responsible person: ��-- �j� C �f Date: r —
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12BO4
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name C7cx •� i sJ ti C ti�t CAS
Location �1
Date C1 , ZZ-q? Permit # 9 2
SOIL TYPE: Sand- Loam-Clay-
Results of Percolation Test-
( if applicable ) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD* Total Length
Length of each trench uZ - -
Depth of trenches
Size of stone
SEEPAGE PITS ' er-
Size - ft4 x ft .
Stone size _ Size ype
PIPING,:
Bldg . Tank
Tank to Dis ox Er
Dist . Box to eld/Pit
openings Seal I a ? ON S :
arts al
LOCAT'IOK/5EPA ON �.feet
Foundation to T nk feet
Foundation to A orp� ti on et
Separation of Pi s o
Conforms as per 1 of P1 an
LOCATION OF SY'S ON PROPER
( circle on �~
Fro - Rear - Left Side �yg �J --��_
Mi dd e i ddl a Rea ,
COMMENTS:
SYSTEM USE APPROVED : E NO
Arriv9di
D
ding In ctor
. �itnldr� . nrconats 5ff -- � c f l� In>
n
{ 56 y
Ll
O F i SERA)
400 k
coiiL
f
BUILD
t}7
"! �are�IM Ir�lr�i�� 1l�
M� �rttrr+M�rr.
REVIEWED Pf