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1988-863 BUILDING PERMIT H X TOWN OF QUEENSBURY w b No. 88-863 WARREN COUNTY, NEW YORK o PERMISSIa)(; )t. N fiereby g a to ed td ' Michael & Virginia Asselin i I Ln 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 a cn rn tt 2. CONTRACTOR or BUILDER'S Name t-' Rollin Graves z Z H. 3. CONTRACTOR or BUILDER'S Address n A) N I—' tZ, 4. ARCHITECT'S Name N rt cm H. d r- W 5. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) rn ( )Wood Frame ( ) Masonry ( )Steel ( ) n W rt rt 7. PLANS and Specifications H N H No. 1000 gal tank, 2 8' x 8' seepage pits as per plot plan, t„ and application. rt rt co 8. Proposed Use rcor Sewage Alteration $ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES November 3 19 90 U, co (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 m Dated at the Town of Queensbury thid Day of Nove -er 19 88 i- rr ro n SIGNED BY for the Town of Queensbury rt Building and Zoni g nspector o• 0 TOWN OF QUEENSBURy T•CWN OF QUEENseU.eV_ ;,ins s • 2 ; 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 y 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 ************************* 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 • 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: • . ocun of Queeniur, BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New-York 12801 � `/ SEPTIC DISPOSAL SYSTEM INSPECTION NAME Cuf ' C/ _- LOCATION /2 5ti,Aa j -7z 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 : i 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. -'/------ —c ''\— / 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 01/86 and vl �w- �L ` x t , fp ' _ \.c) _OQ11 ' N r ! d p r _I .,0 J ,s r U V ISM /