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4. ARCHIT
5. ARCHITECT'S Address
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/
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6. TYPE of Construction—(Please indicate by X)
( 1 Wood Frame ( ) Masonry ( 1 Steel ( 1
7. PLANS and Specifications
No. Septic Alteration as per plot plan specifications
8. Proposed Use
Septic Alteration
$ 25 .00 PERMIT FEE PAID —THIS PERMIT EXPIRES 12/6/95 .1995
(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.)
Dated at the Town of Queensbury this 6th Day o December 19 9 4
SIGNED BY for the Town of Queensbury
Building and Zoni nspector
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'- Application for SEPTIC DISPOSAL:PERMIT
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STAMP R CEI VED
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NOV 14,9
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Location of property for installation: /�
f' f f /CD• t ✓ n i
/`f 2 " / (r : it r y
10
Owner's Name 4., �A/t'O f i /. <5.c'f/.eQJLrR PERMII'4UMBER`
Owner's Mailing Address: J .7�it/pt/r/4 A2D ` Cri
..vhf-4,.�A,, /✓.Y. /2 O 51/ ►�y
J FEE PAID Lr
Installer's Name: 7;43z.r AAP,dit9 Phone #: CA
Number of bedrooms (if residential): 3
Total daily flow (residential -compute @ 150 gal. per bedroom): -?gam
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Topography: 1 Flat I I Rolling i Steep Slope % of Slope \17 o
Soil Nature: Sand I Loam Clay n Other /Depth: Okar/1'/"9cx/ilp/i'ei•vT
Ground Water: at what depth? 4.h 7 %OUlt/G feet
Bedrock or Impervious Material: at what depth? feet
Percolation Test: I I Not Required I —] Required/Rate min. per inch
Domestic Water Supply: I I Municipal r—I Well [] Other 4AKz
If domestic water supply/ is a WELL: water supply from any septic absorption is feet
/I/d 74C.' t/fj,c/9/V44,- �i ,',Q/✓i.4rli' z, /t/O v,t,-,0 L 2 /o
PROPOSED SYSTEM:
Septic tank:/. /)p gal. (minimum size: 1,000 gal.)
Tile Field: each trench feet. / total system length feet.
Seepage Pit(s): number of Z / size each: /2 ft. x ft.
Size of stone to be used: # c3 / depth or thickness 2 feet.
IIOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gal.
Iht Alarm system and associated electrical work to be inspected by a certified agency.
For your protection, please note that pursuant to Section 136-29 o f the Code of the Town of
Queensbury, any permit or approval granted which is based upon or is granted in reliance upon
any material misrepresentation or failure to make a material fact or circumstance known by or on
behalf o f an applicant, shall be void.
I have read the regulations with respect to this application and agree to abide by these and all
requirements o f the Town o f Queensburybu Sanitary Sewage Disposal Ordinance.
Signature of responsible person: 6d.. �`, , /�G' . gC4:Y.i Date: //- ..-7,e
L41,\Q,
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ,Ay (PIN() ev. 4'1,
Location C,Ar,o \)a00, �cl
Date 3 - ��
-'" �"� � Permit #
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches , ,//�
Size of stone ��`
SEEPAGE PITS: Number- 2—
Size - V._ ft. x ,?" ft.
Stone size 3
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box 2"9`
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank /0 feet
Foundation to Absorption 'IC) feet
Separation of Pits o2 .feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPER .
(circle •;
Front 4a - Right Side
Middle •ront - Middle Rear
COMMENTS:
l/ �-
SYSTEM USE APPROVED: OES NO
Arrived: /a To
Departed: ,/"sr
)
Building Inspe r
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date March 16, 19 95
This is to certify that work requested to be done as shown by Permit No. 94-697
has been completed.
• This structure may be used as a Septic Atteration
Location Cleverdale Rd
Owner Margaret Schroder 5 Winding Rd, Delmar, NY 12054
By Order of Town Board
TOWN OF QUEENSBURY
Director of Building &Code Enforcement
•
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•
BUILDING PERMIT
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TOWN OF QUEENSBURY
No. 94-697
WARREN COUNTY, NEW YORK H
PERMISSION is hereby granted to E. Ward & M. Schroder
OWNER of property located at C leverda le Rd Street, Road or Ave.
in the Town of Queensbury,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 Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
a
5 Winding Rd
Delmar, NY 12054 1
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2. CONTRACTOR or BUILDER'S Name N
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3. CONTRACTOR or BUILDER'S Address LQ
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address C
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6. TYPE of Construction—(Please indicate by X) (DD
( 1 Wood Frame ( )Masonry ( 1 Steel ( )
7. PLANS and Specifications
No. Septic Alteration as per plot plan specifications
cn
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8. Proposed Use rt
Septic Alteration 0
H
rt
ID
25 . 00
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 12/6/95 19 95 D
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the I-'•
town of Queensbury before the expiration date.) 0
Dated at the Town of Queensbury this 6th Day of December 1994
SIGNED BY for the Town of Queensbury
Building and Zoni nspector