98-625 BUILDING PERMLIr 1998
VALUE $ 0 TOWN OF QUEENSBURY
No. oQcos:
TAX MAP NO . 101 . - 6 - 6 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to
OWNER of property located at 4 7.TN1]EN Aura Street, Road or Ave.
In the Town of Oueerrsbury. 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 C ieensbury Building and Zoning Ordinance.
t. OWNE WS Address is
KATHLEEN 4 LINDEN AVE .
QUEENSSUR.Y , NY 12804
2. CONTRACTOR or 13UI LDER°S Name
I . B . S . SEPTIC
3. CONTRACTOR of SUlt neRIS Address
2 LOWER WARREN STREET
QUEENSHURY , NY 12804
4, ARCHITECT'S Narne _
S. ARCHITECT'S Address
S. TYPE of Construction — 4Please indicate by X!
SEPTIC
C i YYood Frain► 11 Masonry I ) Steel f l
7. PLANS and Specifications
SEOWIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
a. Proposed Use
SEPTIC; ALTERATION
25 October 6 » 2000
$ PERMIT FEE PAID - THIS PERMIT EXPIRES
(If a longer period is required an application for an extans On owat be made to the Ballding and Zoning inspector of tfr
Sown of Chmmubury before dsa expiration date.)
6 October 1998
Dated at the Town of OueensWry thiis�� Day of tg
SIGNED 8Y � for the Town of Queensbury
�" SUM&" and Zoning I nspeotw
r
y
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No.
Dept. of Community Development
);Z-�
Building & Codes office
742 Say Road Fee Paid $
Queensbury, NY 12804
Location of property for installation:
Property Owner's Name: 42 ,A [ t�Jr CeL— '
// 0 C T �'�(,�, 1998
Property Owner's Mailing Address: `7' e e.
T. c r�
Installer's Name: I )
_ M _ }` ,��r' ,tJ ,,� � Phone # 1
7
Number of bedrooms (if residential.): _W,a Total daily flow:
(residential - compute f 150 gal.lbdrm.)
Topography: Kn t, rolling, steep slope % of slope
Soil. Nature: sand, loam, clay, other ! depth:
Ground water: at what depth wet f Bedrock or Impervious Material: at what depth? _ feet
Percolation test• not required, recuwed [ rate min. per inch ]
Domestic water supply: municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank 6Q Gallon (nin- murn size: 1 ,000
Tile field: each trench feet I Total systems length: 1-21—a— feet
Seepage pit(s): number of / size each: ft by ft.
Size of stone to be used: # f death or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
Alarm system and associated electrical work to be inspected by a cerb ed 7-
For your protection, please note that pursuant. to Section 136-29 of the, Cods of the Town of Qoeeriabury, any permit or
approval granted which is based upon or is granted in reliance xgppon any material misrepresents6on or faiilum to make a
material fact or circumstance known by or on behalf of an applicant, shall be void.
I have read the regulations with respect to this applic and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal 0o mane.
Signature of responsible person: Date: ( �1
Q SUI'LD , "J , UPQWSBURY � r
CODE ENFORCCST
R�+ee742 aY Road
Y NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date _
Pe
SOIL. TYPE- � n
aam-Clay_
Results of Percolation Test-
( if aPP " cable } Rate-Minute/Inch
TYPE OF SYSTEM_
ABSORPTION FIEt_D: Tota Le Length of e h trench ter + �
Depth of tre hes
Size of stone
SEEPAGE FITS ;
Size -
Stone size-� ft
PIPING:
Bldg . to Tank Si'zi'` Ype
Tank to Dist , Box ---�
Dist . Box to Field/i
's Sea7ed?
LOCATIOpeninONt/SEPARATIONYeg
No arl�"t a
Foundation to Tank
Foundation to Absorption feet
Separation a--' Pits feet
Conforms as per Plot Plan et
L
OCATION OF SYSTEM ON PROPERa No
( circle one) _
Front - Rear - Left Side Right Sid
Middle Front Middle Rear
COMMENTS
SYSTEM! USE APPROVED;,
ArrYES NO
Departed:
t
Departeded
;
Building Inspector
G .. f1fa
"I have seen or observed, or believe l saw evidence of, `t
r all objects st.ch as houses, wells, trees, fences, etc,
T iP 1993 shown on this document. l also represent that l have
personally measured the distances set forth on the ding am r
DATE
91: 8
F�I 07
It yitc
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