98-756 TOWN CAE QUEENSBURY
WARREN COUNTY, NEW YORK
Date December 9 19 98
98756
This is to certify that work requested to be clone as shown by Permit No .
has been completed .
SEPTIC ALTERATION
This structure may be used as a
Location 23 PARK ac > --
Owner ROSS , JOAN - -
TAX MAP N0 a 101 . - 5 - 13 By order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. gs� -tac
TAX MAP NO . 101 . - 5 - 13 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to ROSS J A —
OWNER of property located at 23 PARK VT Street, Road at Ave.
in the Town of orueensbury. To 'Construct or place a _ SEPTZC AT TFR nTION
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. O WN E$t% Address is
23 PARKVIEW PLACE
QUEENSBURY , NY 12804
2. CONTRACTOR or BUI LOER'S Nanw
SANITARY SEWER
3. CONTRACTOR or BUILOER'S Addrep
DAN DRELLOS PC) BOX 224
GLENS FALLS NY 12801
4. ARCHITECT'S Name
S. ARCHITECT'S Address
S. TYPE of Construction — IPlsase indicata by }q SEPTIC
I I Wood Frame I I (Masonry I ) Steel l I
7. PLANS and Specifications
SEPTXP ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8, Proposed Use
SEPTIC ALTERATION
25 December 8 Is 2000
S PERMIT FEE PAID THIS PERMIT EXPIRES
Iff a looter period is required an applica ion for an extension ""Am be nu de /0 the Bulldirq and ZnnkV impactor of the
town of gwentbury bete" the ewpiration dafe.l
$ December 1998
Dated at the Town of QueensWry this Day of ]9
SIGNED BY _ for the Town of Oueensbury
n
Suildirp and Zoina InepeAer
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury /
' Dept. of Community I}evelopanent Permit Na {G�
Building &c Codes Office
74 �NY 12804 Fee Paid $Queens �C��
Location of property for installation:
Property Owner's Name: ��77 psf" f
Property Owner's Mailing Addres40V
: 2-2
Installer's Name: JA-Aj ( )t:!1kLjP Phone # 7 V - ? c-%-5 i7
If
Number of bedrooms (if residential): Total daily flow:
(residential - compute Cg? 150 gal./bdrm.)
Topography: flat, roiling, steep slope 9b of slope
Soil Nature: sand, loam, clay, oilier / depth:
Ground water: at what depth? feet I Bedrock or Impervious Material: at what depth? __._ feet
Percolation test: )L not required, required [ rate min. per inch ]
Domestic water supply: municipal, well, ocher
If domestic water supply is a WELL, water supply from any septic absorption is feet.
PROPOSED SYSTEM
Septic tank Oo a gallon (minim um size: 1,000 gal.,)
Tile field: each trench I G'' feet I Total system leggth: 1 i� feet
Seepage pit(s): number of lV l I size each: ft. by ft.
Size of stone to be used. # �' t depth or thickness _� feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
Alarm syslam Aud Associated electrical work to be is spected by a cmuriied asmay.
For yow protection, plan" now that porsacwt to Sectim 136.29 of the Code of the Town of Queenebtuy, any permit or
approval ,granted which is based upon or is granted is reLbuice upon my nuderad or fidlure to a
xnaterial fact or circi> � kmwn by or on behalf of saz sp.l ; shall be void.
I have macs the regulanow with respegs4orth6k application apd agree to abide by these and all requirmnients of the Town of
Qu eembu y sankary Sewage p
Signature of responsible person: f Date: C) o/. — 9 II
c QU r
Quee742 bu Road
EWXI
.r Nr I2804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM! INSPECTION
Name
Location
Da te/
Permit # .�
SOIL TrPE4::
m- Clay-
Results of Percolation Test-
( if applicable ) Rate-Minute/Inch
TYPE OF SYSTEM-
ASSORPTION FI D: Tota Length ��-
Length of a tre
Depth of t nches
Size of s one
SEEPAGE
Size _ ITS , umber-
Stone size ft ' ft .
PIPING:
Bldg . to Tank Size ype
Tank to Dist . Box
Dist . Box to Field/Pit IL„ C
Openings Sealed ? Yes`
,.IoOCATIpiI/SEPARATIONS : a rt a
undation to Tank
(Foundatfon to Absorption feet
Separation of: Pits - feet
Conforms as per Plot Plan —` —feet
LOCATION OF SYSTEM a —�s
(circle one) ON PROPERTY,
Front - Rear - Left Side _ g
Middle Front _ Middle Rear It,
i
SYSTEM
� STl`M USE APPROVED: �,.•� _
Arrived: � •
Depa :
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TOWN OF QUEEN RY
MdrrM1 ► + BUILDING PTO
REVIEWED BY
DATE