1998-742 BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. �At 07 A OD,
TAX MAP NO . 81 . - 1 - 3 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to
OWNER of property Located at Street, Road or Ave.
in the Town of Queensbury. 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. bWNER'S Addwros is
JOSEPHINE 20 MOORWOOD DR .
QUEENSHURYr N . Y . 12804
2. CONTRACTOR or BUILDERS Name
CONDON SEPTIC & DRAIN SERVICE
3. CONTRACTOR or SUILDER"S Address
4. ARCHITECT'S Name
S. ARCHITECT'S Address
ti. TYPE of construction — iPMa" indicate by XI SEPTIC
I I wood Frame I f Masonry I I Steel 1 1
7. PLANS and Speoificatlonr
STeRTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8, Proposed Use
SEPTIC ALTERATION
25 December 1 2000
S _ _ PERMIT FEE PAID — THISPERMIT EXPIRES , 19
Ilf a longer period is required an application for an exteraion awai be made to the Building and Zoning tnapector of the
town of Cknia *dtlury farrow* the eapiratiion data.l
1 December 1998
Dated at the Town of Queensbury this Day of 19
SIGNED BY `KWZonire Imo.
for the Town of Queensbury
euiwirq
Application for SEPTIC DISPOSAL " PERMIT
Town of Queensbury �} J
Dept_ of Community Development Permit No.
Building & Codes Office "
742 Bay Road 01 1"9 Fee Paid
Queensbury, N `Y 12804
Location of property for installation:: 2.4 ey ,,E`+G.r 6:74 3Wt
Property Owner's Name: ( Qv�¢&sy C ^ '!�,¢ ?� NOV 1998
Property Owner's Mailing Address: SLOQfJ/QlE lt7L3ea� J "C r _
Installer's Nae, L' ./" r#J" S .'�-rC +
m G q4-1ll.� Phone #
Number of bedrooms (if residential): Total daily flaw:
(residential - compute Q 150 gal.lbdrrn.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: X sand, Ioam, clay, other / depth:
Ground water: at what 4.0 - feet I Bedrock or Impervious Material: at what depd feet
Percolation test: ,2L not required, required [ ratz min. per inch ]
Domestic water supply: municipal, well, other
domestic water supply is a WELL, water supply la om any septic absorption is feet.
PROPOSED SYSTEMM � r
Septic tank:1 )(1 gallon (minimum size: 1 ,000 mil.)
Tile field: each trench feet I Total system length.: feet
Seepage pit(s). number of t size each: . ft, by ft.
Size of stone to be used: rr — - - ! depth or thickness +''' feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Sipe of each: gallons
Alarat system and associated electrical vvlcr : to be suspected by a certified agency.
For your protection. please note that pursuant to Section 136-29 of the Code of the Towm of (20ftasbwy, any pern3ft or
approval graded which is based uport or is granted is reliance upc+n any material sui,sregresenta oa or fa.$ure to make a
rn.ster:al fact or circumstance yawn by or on behalf of an applicamt, shall be void.
I have :ead. the regulatiom with, respect to this aprpUcration and agree to abide by theoe avd aId requirements of the Town. of
Queensbury Sanitary Sewage Disposal Ozdb=rkro.
Sig arure of responsible person: Bate:
TOWN OF QYUEENSSURY
BUILDING & CODE ENFORCEMENT
742 Say Road
Queensbury MY 12804
(518) 761 -8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
[late Permit # � .
SOIL TYPE : Sand- Loam- Clay-
Results of Percolation Test-
( if applicable ) Rate-Minute Inch
TYPE OF SYSTEM:
ABSORPTION FIELD : 'total L ngth
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS : Number-
Size .
Sizeze - �•,�—`—, x
Stone size Size ype
PIPING:
Bldg . to Tank -----
Tank to Dist . Box
Dist . Box. to 'Field/Pit ,�—�
Openings Sealed ? Yes No Partial
LOCATIONf'SEPARATIONS : feet
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits — Yes No
Conforms as per Plot P1 a
LOCATION OF SYSTEM ON PR PERTY :
( circle one )
Front - Rear - Left Side - Right Side
Middle Front - Middle R r
COWENTS
SYSTEM USE APPROVED : e' YES N0
Arri v
Depa ed :
n ctor
Conn Rhj) K Z R Cans tea 5 �t r'G 4 31A I U SFA T1vc
6
FN S r3u E R� t 91q Lft�us s ICJ. L�Q
4�
r
fic
TOWN OF QUEENSBURY ��■ �t�4�4�,
BUILDING & C E EPT. 3 'SPA �te �attrt�ttM
� w � �s�ti�rMi�w,•
REVIEWED BY
DATE f �-�