98-758 BUILDING PERMIT
VALUE $ e TOWN OF QUEENSBURY No.
TAX MAP NO . 101 . - 5 - 12 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to W -
OWNER of property located at
22 JEROME Street. Roar! 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 end Zoning Ordinance.
t. OWNERS Address is
7 9 GLENWOOD AVE .
QUEENSHURY , NY 12804
2. CONTRACCTOR or SUILDERZ Name
I . B . S . SEPTIC
3. CONTRACTOR or BUILDER'S` Address
2 LOWER WARREN STREET
QUEENSBURY , NY 12804
i. ARCHITECTS Name
5, ARCHITECT*S Address
E. TYPE of Construction IIIII. ipkase indiCato bV K1 SEPTIC
l l wood Grams I I Maw#wv l i ..
7. PLANS and Specifications
Na.
rse
roposed U
SEPTIC ALTERATION
25 December1@ t$ 2000
$ PERMIT FEE PAILS - THIS PERMIT EXPIRES
(If a longs► Period is required an application tow an extension .rtust be rntda to the Buiklkq and 2onirg in�attor of she
town of oueendwrV before fire ewpiration data»I
10 December 1998
Day of 1g
Dated at the Town of Oueensbury this �---
SIGNED 8Y ,+� �-A•- eTMw - for tlta Ttlwrt of t�uaansburY
a To rig lristtretw
Application for SEPTIC DISPOSAL L PERMIT
Town of Queembury
Dept. of Community Development Permit No.
Building & Codes Office C �"[� b 742 $av Road Pee Paid
Queensbury, Nv'Y 12904 r \
Location of property for installation: CA . k. c
Property Owner's Name: fir A r r" C +^ C. u.- ±: 4 A- / C4 C Q 11998
Property Owner's Mailing Address: ffs" C .., oa t.- - JL- I C.
Installer's Name: r S ! Phone #
Number of bedrooms (if residential): Total daily flow:
(residential - compute @ 150 gal./bdrni.)
Topography: ! 1 fiat, rolling, steep slope % of slope
soil Nature: sand, loam., clay, other I depth:
Ground water: at what depth?N feet I Bedrock or .Impervious Material: at what depth? _ feet
Percolation test: / not required, required. [ rate min, per inch. ]
Domestic water supply: )C 'anunicipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM [.vuS i t n� 3 u C . rt ,�,h..:,..Te"r 0 n &may.
Septic tankrl9r^_ gallon (m/�inirrturn site: I ,000 gal.)
Tile field: each trench �r t/ feet I Total system length: feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: # I depth or thickness feet
1
HOLDING TANK SYSTEM: Cif required)
Number of tanks: Size of each.- CP
mesons
.A.lsurm systam and associated etectrical work tv be inspected. Tay a certiS.ed agenc-y.
For your protwdm please note that pursuant to Section 136-29 of the Coda of tho Town of Qoeensbury, any permit ar
approval granted which is based upon or is granted is reliance upon any material raisrepresentation or bulure to make a
r nth -int fact or rirclraLstsince kno%n by or on behalf of an applic�aot, shall be void..
I Dave rears the regulations with respect to this lication and agree to alside by these and an requiremeuxs of the Town of
Queensbusy Sanitary Sews.ge Dispowd
Signature of responsible person: //Date: /C)
TOWN OF QUEENSBURY
BUILDING A CODE ENFORCEMENT �, /'
742 Bay Road
Queensbury MY 12804 - �----
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location r�
Date ermit #��_� 4
SOIL TYP Sand- Loa ay-
Results of Percol ati on Te t-
( if applicable ) Rate- Minut /Inch
TYPE OF SYSTEM:
ABSORPTION FIELD : Total Len
Length of each trench +
Depth of trenches
Size of stone
SEEPAGE PITS : Number-
Size - ft %, x ft .
Stone size _
PIPING :
Bldg . to Tank
Tank to Dist . Box Ai- �Q
Dist . Sox to Field/P
Openings Sealed ? Y No Vartial
LOCATION/SEPARATIONS : / feet
Foundation to Tank
Foundation to Absorp ti a feet
Separation of Pits eet
Conforms as per Plot Plan es No
LOCATION OF SYSTEM ON PRO R
( circle one ) ht Side
Front - Rear - Left S - 9
Middle Front -
COMMENTS:
r
SYSTEM USE APPROVED= YES NO
Arrived :
Departed :
Building Inspector
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( JO
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IRY
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BUILDING &
PT.
4
REVIEWED BY
DATE
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