98-613 PERMIT
VALUE $ 0 TOWN OF QUEEWSBURY No . 98613
TAX MAP NO . 125 . - 4 - 2 WARREN COUNTY, NEW PORK
PERMISSION is hereby granted to DUNCAN r JOHN & ANITA
OWNER of property located at 14 LANTERN HILL RD . Street. Road or Ave.
in the Town of Oueensburve 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 aueensbury Building and Zoning Ordinance.
t. OWNER'S Address is
14 LANTERN HILL RnII,
QUEENSHURY , NY 12804
R. CONTRACTOR or SUI LDER'S flame
I . H . S . SEPTIC
LiN LR�C�R owutR(EEN STREET
QUEENSHURY , NY 12804
4. ARCHITECT'S Name
5, ARCHITECT"S Address
6, TYPE of construction — (please indicate by Xf SEPTIC
I Wood Frame ( I Masonry ( i Steel l F
7. PLANS and Specifications
SEPV,C ALTERATION AS PER PLOT PLAN SPECIFICATIONS
a, Proposed Use
SEPTIC ,ALTERATION
25 September 30 2000
$ PERMIT FEE PAID - THIS PERMIT EXPIRES , 19
(If a longer period is requwed an application for en extension must be made to the Building and Zoning inspector of the
town of Ousansbury before the expiration dare.)30 September 1998
Dated at the Town of Oueensbury this Oey of t9
SIGNED BY � for the Town of Clueensbury
Building and Zoning trtspocw
` Application for SEPTIC DISPOSAE PERMIT
Town of Queensbury --
Dept. of Community Development Permit No. �
Building & Codes Office c '
742 Bay Road Fee Paid $
Queensbury, NY 12804 ,,rr
Location of property for installation. 400x Z�c r •'� - t„�
5�.��Crl 1998
Property Owner's Name: �z4,/'{Z, T6,- 1-0 tan.
Property Owner's Mailing Address:
Installer's Name: Jr Phone # '`
Number of bedrooms (if residential): f Total daily flow 0
(residential - compute (& 150 gal.lbdrm.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: +'1 sand, loam, clay, tither f depth:
Ground water: at what depth`,/(d feet / Bedrock or Impervious Material: at what depth? ____ feet
Percolation test*WWnot required, required [ rate min. per inch
Domestic water supply: m cipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank: � gallon (mrfimd size: 1 ,000 gal.)
Tile field: each trench 5G) feet I Total system length:, Ld feet
Seepage pit(s): number of I size each: fL by ft.
Size of stone to be used.: # / depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: ;allons
Alartxi system and associated. eEectrlcal w+oxic to ba inspe+cted by a crsrti&ed agency.
For your protection, please note that p.srsumal to Section 136-29 of the Code of the Town of Qoeensbury, any Permit or
approval granted which is based upon or is granted iRl reliance upon any materiel ansrepresentzbOa or failure to nudes a
miter a9 fact or caxa *Y+stanoe lmown by or on behalf of an applic nt, shall be Void..
I have read the regulations with respect to this applic and agrOe to abide by these and ail raquixemeots of the Town of
Queensbury Sanitary Sewage Digq >sal Ordmanca
Signature of responsible person: Date: ^� �
i
w
x
TORN OF QUEE'NSBURY
BUILDING & CODE ENFORCEMENT ,
742 Bay Road
Queensbury NY 12804
(518) 761-82%
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location J
Date - ( ` Perini t # ` f
SOIL TYP Sand oam-Clay-
Results of Percolation Test-
( if applicable ) Rate-Minute/ Inch ,
TYPE OF SYSTEM: s
ABSORPTION FIELD : Total = --
Length o each trench I
Depth of renche
Size of sto
SEEPAGE PITS : u er- ft -
Size - f - x ----.
Stone size _ Si.z Type
PIPING:
PIPING:
Bldg , to Tank
Tank to Dist * Box
Dist . Sox to Field/P Pam
openings Sealed? Yes o
LOCATION/SEPARATION feet
Foundati,d'n to Tank feet
Foundation to Absorption et
Separation & Pits $ o
Conforms as per Plot Plan
LOCATION OF SYSTEM ON PROPERTY :
( circle one) - Left Side - Right Side
Front -
Mi ddl ron t - Middle Rear
Cape
SYSTEM USE APPROVED =
Arrived : YES No
-r
Departed :
Building Inspector
T f0j W
REVIEWED %6 'f
- DATA Sir ? } IMIS
Tom. c . 7T& '
/"X C [�
"r have seen or obsenW. or bellm 1
all objF
such as houses #�
Showntails doCIu mmIt. 1a6aTOWN Of QjjCrNsj3U 6UIMING DEPARTMENT per�son red HM 1MMt 1 a�
Based on our Nmited examination, M �! w
compliance with our comments shag
not be construed as indicating the SIGMA
ins and specifications are in full
DATU
com Wanpp with tte code.
[(D L`
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