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89-138 BUILDING PERMIT TOWN OF QUEENSBURY No. 89-138 WARREN COUNTY, NEW YORK z PERMISSION is hereby granted to Henry & Helen Sander oo OWNER of property located at Box 1728 Glen Lake Road Street, Road or Ave. in the Town of Queensbury,To Construct or place a Sewage 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 Queensbury Building and Zoning Ordinance. 1. OWNER'S Address is Same cn Iv 2. CONTRACTOR or BUILDER'S Name Morning Star Excavating, Inc. 1-1 Frank Shaw 3. CONTRACTOR or BUILDER'S Address (p 128 Kobor Road n Gansevoort,N.Y. 12831 4. ARCHITECT'S Name lD N 5. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) bd 0 ( 1 Wood Frame ( 1 Masonry ( 1 Steel ( ► 7. PLANS and Specifications oo No. Repair (restone) only existing drywell as per plot plan, 0 and application. 8. Proposed Use L—' Sewage Alteration In 25 . 00 PERMIT FEE PAID —THIS PERMIT EXPIRES Nib April 6 1�1 (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Queensbury before the expiration date.) cn (l) 0 Dated at the Town of Queensbury this 6th Day of April 19 89 �q SIGNED BY for the Town of Queensbury Building and Zoning Inspector (D Sv rt O TOWN/ OF QUEENSPURY ;t } "$ I !, 1 < ' TOWN OF QUEENSBURY APPLICATION FOR RECEIVED . 5 > SEPTIC DISPOSAL PERMIT APR 4 1989 BLDG. & CODE DEPT. DATE I-( - 3 — LOCATION OF PROPERTY FOR INSTALLATION Glen Lake Rcacc Owner's Name: ken( �I cuoct E-lete v, Scmck_A Telephone: TBB-B:3?-1 Address: R R*1 30x C-'\e Lake Road Lake G eo r12 iV if lae i_c //e,6,-r 6".'ecedet.-_,,---ie _1, Installer's Name- • 1rL6met42Qrelephone: -79 3 -ails 793^-eY9 Number of bedrooms (residential only) a Total daily flow (compute (d 150 gal per bedroom) 300 Topography: Circle one:O Rolling Steep Slope % of Slope Soil Nature: Circle one:(and,.- oam)Clay Other /Depth: Feet Ground Water: At what depth? N/P Feet Bedrock or Impervious Material: At what depth? N/P 9 Feet Percolation test: Circle one: (jot required)required rate min. inch. Domestic water supply: circle one: Municipal Well Other If domestic water supply is a well: Separation: Water supply from septic absorption iJ JA feet PROPOSED SYSTEM: Septic Tank 1200 * gal. (minimum size: 1,000 gal.) TILE FIELD: Each Trench N fls, feet/Total system length •1••N)1+ feet SEEPAGE PIT(S): Number of / Size each feet by feet Size of stone to be used # /Depth or Thickness 5vrge ti_h e ks- 1.1. feet ************************* I have read the regulation on the reverse side of this sheet and agree to abide by these and all requirements of the Town of Queensbury anitary Sew ge Disposal Ordinance. SIGNATURE OF RESPONSIBLE PERSON: c„-,44 DATE: Y f 3/67 OVER Z/K- s> C> rsp'C (7k7 &-' // awn of Queeniur, BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98,-7///� Queensbury, New York 12801 /7 -- SEPTIC DISPOSAL SYSTEM INSPECTION NAME >(7 2c.4(.,.f --) 2(:-/i1Y5 LOCATION 46 M % , DATE '/// 6y PERMIT NO. j 9— /�(- SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field, total length Length of each trench Depth of trenches Size of gravel_ SEEPAGE PITS{Number of) Size- ft. X _ ft. Gravel size PIPING: Size Type Bldg. to tank Tank to dist. box Dist. box to field/pit Openings sealed? YES NO Partial LOCATION/SEPARATIONS: Foundation to tank ft. Foundation to absorption ft. Absorption to lot line ft. Separation of pits ft. LOCATION OF SYSTEM ON PROPERTY(circle one) Front - Rear - Left side - Right side - COMMENTS A6X (5 -1--V760, S t.-Pil&.11:-- 0 i T- /Vt-W c2STO j S42_120 WU ()JJ& nL2 P�ML� SYSTEM USE APPROVED 6;-) Buil ing Ins ector 01/86 and vl ^ | _ _ t ' - / - - -- - ` ' | _ 2 - Ems, Nor ' `aUse _ � - 7 | ' � | | � - � v � _ ' • A/:111:11 CERTIFICATE OF INSURANCE ISSUE°11/23/888 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, Jack Robinson Asso. , Inc. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW P O Box 1364 71 Saratoga Ave So. Glens Falls, NY 12803 COMPANIES AFFORDING COVERAGE COMPANY ANY ALETT Globe Indemnity CODE SUB-CODE COMPANY INSURED LETTER B Hartford Ins. Co. Frank Shaw dba COMPANY LETTER C Morning Star Excavating, Inc. 128 Kobor Road L TTERNY D Gansevoort, NY 12831 COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS ItLTR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ 300 IIII A X COMMERCIAL GENERAL LIABILITY GYAE93418 04/15/88 04/15/89 PRODUCTS-COMP/OPS AGGREGATE $ 300 CLAIMS MADE X OCCUR. PERSONAL&ADVERTISING INJURY $ -- OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ 300 FIRE DAMAGE(Any one fire) $ --- MEDICAL EXPENSE(Any one person) $ -- AUTOMOBILE LIABILITY COMBINED III ANY AUTO LIM TLE $ 300 ALL OWNED AUTOS OluECPR5270 03/23/88 03/23/89 BODILY INJURY $ x SCHEDULED AUTOS (Per person) B HIRED AUTOS BODILY - INJURY $ NON-OWNED AUTOS (Per accident) GARAGE LIABILITY PROPERTY DAMAGE EXCESS LIABILITY EACH AGGREGATE OCCURRENCE $ $ OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY AND $ 100 (EACH ACCIDENT) (DISEASE—POLICY LIMIT) EMPLOYERS'LIABILITY $ 500 B 01WECJM0524 04/13/88 04/13/89 $ 100 (DISEASE—EACH EMPLOYEE) OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION Tcxnm of Queensbury SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Bay at Haviland Rd. EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Queensbury, NY 12804 MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE ATIN" Dave Hahn, Director of Building LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR • & Code Enforcemlent LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED RE ESENTATIVE VI ACORD 25-S(3/88) • ©ACORD CORPORATION 19881