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BUILDING PERMIT �
TOWN OF QUEENSBURY �
Na. 87-416
WARREN COUNTY, NEW YORK a
PERMISSION is hereby granted to Robert Archambault
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OWNER of property located at 7 Carlton Street, Road or Ave. nNs
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.
t . OWNER'S Address is
7 Carlton Dr .
Queensbury , N . Y . 12801
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2_ CONTRACTOR or BUI LCIE R'S Name
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Sanitary* Sewers n
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3. CONTRACTOR or BUILDER'S Address
03
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P . O . Box 224
Glens Falls , N . Y . 12801 ril
4. ARCHITECT'S Name
S. ARCHITECT'S Address
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6_ TYPE of Construction — (Please indicate by X)
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( i Wood Frame ( 1 Masonry I l Steel l )
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7. PLANS and Specifications
No. 2 61 x 8 ' dry wells , distribution box * per plot plan and application. .
B. Proposed Use
Sewage alteration
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$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES July 6 , 19 89 n
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(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Clueanshury before the expiration date.) n,
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Dated at the Town of Queensbury this 6th Day of July 19 87 �
SIGNED BY -for the Town of Queensbury
Building and Zoning Inspector
APPLICATION FOR SEPTIC DISPOSAL !' IOU
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� BUlLL7fiV 8c C DE DEP'3'.
DATB, lam_ _ / .___.-�L l
LOCATION OF PROPERTY FOR INSTALLATION -^-�
Owner's Name: UY � Ir�1 P � �;�Telephone: '�7— / / 3 E5
Address;
Installer's Name: Cl Jt dn Telephone:
Number of bedrooms (residential only)
Total daily flow (compute (LP 150 gal per bedroom)
Topography: circle one: la Rolling Steep Slope %a of slope
Soil Nature*. circle one: an Loam Clay Other / Depth: feet
Ground Water: At what depth? feet
Bedrock or Impervious Material: At what depth? '�- feet
Percolation test: circle on not required~ required { rate m in. inch.
Domestic water supply: circle one Municipal Well Other
IF domestic water supply* is a Well:
Separation: Watersupply from Septic absorption _ feet
J� �r-)D o gok min I�"`i ram"�
PROPOSED SYSTEM : Septic Tank f L/'CJ '� 7. (minimum size: 1 ,(}04 gal.)
TILE FIELD: Each Trench feet / Total system length feet
SEEPAGE PIT(S) : Number of / Size each feet by feet
Size of stone to be used # / Depth or Thickness feet
I M P O R T A N T
...Please...LIST NEW EQUIEP"MENT TO BE INSTALL IM
(over)
�70W" n� �up�rt3hury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Oueensbury, New York 12801
SEPTIX DISPOSAL SYSTEM I SPECTION
NAME Qr
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LOCATI
DATE (r 'g�/ PERMIT NO u� VW0
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 TS{Numbe of } y
Size-- ft. X ft - `
Gravel size _5
PIPING : Size T
Bldg * to tank L
Tank to dist . box
Dist. box to field L-
Openings sealed? YES NO Partial
LOCATION/SEPARATI {
Foundation to tank / �� ft.
Foundation to absor tion �ft. `p
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Absorption to lot line 02If- t._
Separation of pits
TACATTON YSTEM ON PROPER
Front � ear Left side - Rig lit ' Si
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COMMEt74
SYSTEM USE APPROVE YES NO
Build ' :g;dpe for
01/86 and vl