1989-610 _a
BUILDING PERMIT "
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TOWN OF QUEENSBURY No 59- 610 _
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Rohort nal aha
OWNER of property located at i vi ca ti on Road Street, Road or Ave.
in the Town of Queensbury, To Constructor 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_
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1. OWNER'S Address is 1~
Same
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2. CONTRACTOR or BUI LDER S Name
Condons Septic
3. CONTRACTOR or B111 LDE R'S Address
Glens Falls , M . Y . 12801
4. ARCHITECT'S Name l U'-
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S. ARCHITECT'S Address
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6_ TYPE of Construction — (Please indicate by X)
i ) Wood Frame { ) Masonry 11 Steel 11
7. PLANS and Specifications
No. 1000 gal . tank , 1 6 ' x 8 ' seepage pit for grease trap as per plot plan
and X15OXXXXl INK application C„
B. Proposed use Qj
Sewage Alteration m
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s 25 , 00 PERMIT FEE PAID — THIS PERMIT EXPIRES K# July 31 19 gl
(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 31st Day of July 19gtg.^_
SIGNED BY for the Town of Queensbury
ding and ZoniWinspector
TOWN OF QUEENSBURY
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/'��•- .,��. APPLICATTON FOR y .� 1 d s.: � r .�
-=vim SEPTIC C POSAL PERMI'1t.,Ir'*,P' ! � `+,.'r i:.� a t
DATE
DATE _ C, ;:«
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LOCATION OF PROPERTY FOR INS} 1`7TA rLLA N
Owner's Name: o22 °? _� L_ A 1r�Telephone; Y.(Z3}
Address: //,
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Installer's Name: L vo;,'' rD. 'l iy _> ; r c.- Telephone: --
Number of bedrooms (residential only)
Total daily flow {compute (d 150 gal per bedroom) '
"Topography: Circle one: eFlat Rolling Steep Slope % of Slope
Soil Nature: Circle one: and Loam Clay Other /Depth: Feet
Ground Water: At what depth ? f Feet
f
Bedrock or Impervious Materials At what depth ? Feet
Percolation test: Circle one: not required required rate min. inch.
Domestic water supply: circle one: 'Iunicipal Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank�/Q6 (1 gal. ( minimum size: 1 , 000 gal.) � � X'414
TILE FIELD: Each Trench feet/Total system length Feet
SEEPAGE PIT(S): Number of _ /Z Size each feet by feet
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Size of stone to be used # /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 Queensbury Sanitary Sewage Disposal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: ^�
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DATE: /--7"
OVER
Septic System Inspections ;
.� • 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 azid shall include a plot plan showing :
1 . ) the proposed location of the system
? . ) 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 . Nu system shall be covered before inspection and approval by the
Building Iirspuctor . Failure to comply with this requirement may
a- esult 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
c: ont3truccion .
Town of Queensbury
BUILDTNG and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
Remarks
._.J'own 0/ Queen .thury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98 �
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME 4� �/e
LOCATION fr7 c114s
DATE I PERMIT NO. a
SOIL TYPE -� nd w am - Clay
PercolationNTest Required? YES '~ NO
Percolation mate - Min/Inch _
TYPE of SYSTEM
Absorption fie total 'length
Length of each trench
Depth of trenche$ _
Size of gravel_
SEEPAGE PITS{NUMb )
Size- r ft. X _ t.
Gravel size
PIPING : S ' e, Ty e
'Bldg _ to tank__
Tank to dirt_ box _ ---
Dist . box to fie ?�
...X.-...._...._..�
Openings sealed? E NO Partial
LOCATION/'SETA IONS :
Foundation to ank
Foundation to bsorption`` �ft *lot line ft.
Absorption to
Separation o pits
OF YSTEM ON PROkERTY (circle one)
Front Rear - Left side -`, Right side -
SYSTEM USE APPROVED NO
Buildln4 Anspector
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