1989-612 su
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BUILDING PERMIT
TOWN OF QUEENSBURY
No. 89- 612 �
WARREN COUNTY, NEW YORK �-
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00
PERMISSION is hereby granted to
OWNER of property located at lr9 Midnight Teri va
Street, Road or Ave.
in the Town of Queensbury, To Construct or place a SewA gp Al €prat ; nn
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.
n
1 . OWNER'S Address is �-
Same
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2. CONTRACTOR or BUI LDER% Name �d
Bill Threw
3. CONTRACTOR or BUILDER 'S Address
Glens Falls , N . Y . 12801
d. ARCHITECT'S Name
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5. ARCHITECT'S Address '4
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S. TYPE of Construction .- (Please indicate by X) rD
1 1 Wood Frame ; I Masonry ( 1 Steel ( 1
7. PLANS and Specifications
No. Existing tank , 2 6 " x 8 ' seepage pits as per plot plan and
application .
B. Proposed Use
G/1
Te
W
Sewage Alteration90
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A
$ 25 , 00 PERMIT FEE PAID -- THIS PERMIT EXPIRESHaYGh 1 19 M
0f 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.} `+
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Dated at the Town of Queensbury this 2nd. Day of AKXX August 19 89
SIGNED BY -% 4for the Town of Queensbury
Building and Zoning Inspector
OWN OF QUE orsByrY �''�,44ze
TC3I+'VN OF QUEENS®L!R'Y
APPLICATION FOR RECEIVED
. �
v } SEPTIC DISPOSAL PERMIT
QUG
198.9
BLDG, & 'CODE DEpT.
DATE / / r 9'
LOCATION OF PROPERTY FOR INSTALLATION / 2- �
Owner's Name: i f/ • ' Telephone: 1%`,
Address* 1 ,,7
Installer's Name. Telephone: / - 7S
Number of bedrooms (residential only)
Total daily flow (compute Ca 150 gal per bedroom )
Topography: Circle one(:"'Flat Rolling Steep Slope % of Slope
Soil Nature: Circle one: Sand/ 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 rate min. inch.
Domestic water supply: circle one: Municipal Well Other
if domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank gal. ( minimum size: 1 , 000 gal. )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of 2 / Size each ep feet by feet
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Size of stone to be used #_4� _/Depth or Thickness 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 Sanitary Sewage Disposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
DATE: `� .. f 2::Z
OVER
Septic S)rstenr 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 ,
the fields and. / or drywells
13 . Nu :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
Uf 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
curistruct ion
.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Say and Haviland Roads
Queensbury , New York 12804
Kua�arks
f o+wn 01 Queen31 ury
BUILDING and ZONING DEPARTMENT
Say and Havifand Road, R-d. 1 BOX 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME �7 C
LOCAT I ON
DATE PERMIT NO .
SOIL TYPE - Sa d - Loam - Cl�tl y -
Percolation Te Required? ES - NO
Percolation rat - Min/Inc -
F
TYPE of SYSTEM!
Absorption field , total , ength
Length of each tr ch
Depth of trenches
Size of gravel ° ----
SEEPAGE PITS-(Number J
Size- �fr`t. X t.
Gravel size'- ------- -�
PIPING : Size , • Type
Bldg . to tank
Tank to dist. box
Distw box to fiel
Openings sealed? YES / NO Partial
LOCATION/SEPARA yIONS :
Foundation to 'tank
Foundation to bsorption ft .
Absorption t0 tiat line ft.
separation og pits c
ircle one)
LOCAN rON ofSYSTEM
ON PR
OPE ER({c
Fronk. - Rear - Left side - Right side -
TS : / ,r
f pu
SYSTEM USE APPROVED ES % NO
BuildJr1%g inspector
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5 � 1tC TANK r
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rOWN OF U�
� ESBURY
6 ES E;PT4
REVIEWED BY
DATE
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