1988-863 BUILDING PERMIT H
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TOWN OF QUEENSBURY w
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No. 88-863
WARREN COUNTY, NEW YORK o
PERMISSIa)(; )t.
N fiereby g a to ed td ' Michael & Virginia Asselin i
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OWNER of property located at 6 Carroll Street Street, Road or Ave. o
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
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2. CONTRACTOR or BUILDER'S Name t-'
Rollin Graves z
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3. CONTRACTOR or BUILDER'S Address n
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4. ARCHITECT'S Name N
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
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( )Wood Frame ( ) Masonry ( )Steel ( ) n
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7. PLANS and Specifications H
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No. 1000 gal tank, 2 8' x 8' seepage pits as per plot plan, t„
and application. rt rt
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8. Proposed Use rcor
Sewage Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES November 3 19 90 U,
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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 W
town of Queensbury before the expiration date.) OR
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Dated at the Town of Queensbury thid Day of Nove -er 19 88 i-
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SIGNED BY for the Town of Queensbury rt
Building and Zoni g nspector o•
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TOWN OF QUEENSBURy T•CWN OF QUEENseU.eV_
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; APPLICATION FOR `�
�t N1 - ���_.\� .'4ry` ` =v � Y SEPTIC - DISPOSAL PERMIT wati 3. 1988
BUILDING & CODE DEPT.
1111
DATE tI- 3 -
LOCATION OF PROPERTY FOR INSTALLATION to e i rrY 1 ) 54. ( U P'Pf(S bur L
Owner's Name:J4;<e -4 AsseLiN Telephone:
Address:. (p CArrQ S4• 009ewsbor
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Installer's Name: RO I/n.J (r(vPS Telephone: 639 " `!(4.2-6
Number of bedrooms (residential only) 3
Total daily flow (compute @ 150 gal per bedroom) LIS
Topography: Circle one lat Rolling Steep Slope % of Slope
Soil Nature: Circle one: and Loam Clay Other /Depth:. Feet
Ground Water: At what depth? Feet
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle one: not required required rateb•-_ min. inch.
Domestic water supply: circle one: unicipal Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM: Septic Tank 1j 000 gal..(minimum size: 1,000 gal.)
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of 1 / Size each 8 feet by e feet
Size of stone to be used # 3 /Depth or Thickness Z' feet
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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 Queensbur Sanitary Sewage Disposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: c2L—et.vk—c
DATE: J I- 3 - 8f5
OVER
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Septic System Inspections:
A. All applications for septic system installation, alteration or repair,
as required by the Town of Queensbury Sanitary Sewage Ordinance, shall
be submitted to the Building Department at least 24 hours before start
of construction and shall include a plot plan showing:
1.) the proposed location of the system
2.) location and distance to lot lines
3.) location and distance to structures •
4.) location and distance to any water supply
5.) size and dimensions of all tanks, distribution boxes,
tile fields and/or drywells
B. No system shall be covered before inspection and approval by the
Building Inspector. Failure to comply with this requirement may
result in the uncovering of the system by the installer and a fine
of up to $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may
result in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installa—
tion, alteration or repair of an approved system, a new proposal must
be submitted to the Queensbury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
Remarks:
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. ocun of Queeniur,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New-York 12801
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SEPTIC DISPOSAL SYSTEM INSPECTION
NAME Cuf ' C/ _-
LOCATION /2 5ti,Aa j
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DATE//'JU n- PERMIT NO. 0 U to ��
SOIL TY E - Sand - Loam - Clay :-
Percola ion Test Required? YES - NO
Percolat'on rate - Min/Inch :
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TYPE of S \STEM: 1i •Absorption\ field, total length
Length bf each trench /
Depth of trenches /
Size of gravei\ /,_
SEEPAGE PIPS4Nuinber of) ' / 2—
Size- („ft. X ft. -'/------
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Gravel size
PIPING: SizeType
Bldg. to tank ? ,, .,�1 L
Tank to dist. box L , pvc___,
Dist. box to field/.'!
Openings sealed? ES Partial
LOCATION/SEPARATIONS:
Foundation to tank / ft.
Foundation to ab on 4.orpti <i ft.
Absorption to lot line •i, ft. \
Separation of :pits ,L r ft. \
LOCATIONAFTSYSTEM ON PROPERTY(circle one)
Front -('Rear/ Left side - Right side -
COMMENT ',
z),-42 0 /447L, •
SYSTEM USE APPROVE YES NO
Building Inspector
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