1990-391 BUILDING PERMIT y
TOWN OF QUEENSBURY m
No. 90-391
eJAFARREN COUNTY, NEW YORK *d
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PERMISSION is hereby granted to JOHN BREARLEY ,-..
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OWNER of property located at B Burch Rd Street, Road or Ave. ND
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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.
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1. OWNER'S Address is
RD#3 Box 247 Burch Rd tt
9
Queensbury NY 12804
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2. CONTRACTOR or BUILDER'S Name I-o
Sanitary Sewer
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( I Wood Frame ( ) Masonry ( I Steel ( )
7. PLANS and Specifications
No Sewage alteration as per plot plan, specifications and application. W
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8. Proposed Use aq
Sewage alteration
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES June 18 19 92 z
(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 5th Day of „June 19 90
SIGNED BY (/1'----/ 6Z h>/ 2 for the Town of Queensbury
Building and Zoning In r
ew� �/ 0 OWN OF QUEENSBURY
c �j jU9, . APP , :\+,`. F R EPTIC DISPOSAL PERMIT
DATE CP'45' 90 44
, -. H LOCATION OF PROPERTY FOR INSTALLATION �', )�r ` t , ' � //Lc9ct f tva.a
Owner' s Name:cjO -,e/ KtiCA-ALel-- JUN 1 8 1990
Zu �Address: rD 3 R o �� /A-e/ 4i
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B'J D.. . cu L3 �.
Installer' s Name: X /� (/ -' Telephone: 7- ' Z27
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom) W?
Topography: Circle one: 00'
Rolling Steep Slope % of Slope
Soil Nature: Circle one: 0. Loam Clay Other /Depth:
Ground Water: At what depth? Feet .
Bedrock or Impervious Material : At what depth? Feet
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Percolation test: Circle one: ofrequired required
Rate - Min. Per Inch
Domestic water supply: Circle one: 0011ft. Well Other
If domestic water supply is a wel
Separation: Water supply from any septic absorption feet.
PROPOSED SYSTEM: Septic Tank )(Z) 1 gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench JD feet/Total system length 20 D feet
SEEPAGE PIT(S): Number of /Size each feet
by feet
Size of stone to be used #. 2-- /Depth or Thickness '1 feet
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HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal .
*Alarm system and associated electrical work to be inspected by an approved
agency.
I have read the regulation on the reverse side of this sheet and agree to abide
by these and all requirements o Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: -`J _DATE: (6.r/�".
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Septic System Inspections:
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A. All applicationi 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,
- - fields andior d-rywells - -
B. No system shall be covered before inspection and approval by the
Building Inspector. Failure to comply with this requirement may
rosult 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 co produce said plot plan at time of inspection may
result in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installa- •
cion, alteration or repair of an approved system, a new proposal muse
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
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_Down 4 2ueen96ur,
BUILDING and ZONING DEPARTMENT
Bay a Id Haviland Road, R.D. 1 Box 98
0 eensbury, New York 12801
SEPTIC OISPOSAL SYSTEM I.NSPECTJON
NAME 2L - ieZ
LOCATION ., ? /k ?A -
DATE �Z�1f r PERMIT NO. G I
SOIL TYPE - `' Loam - Clay
Percolation Test Required? YE' - NO
Percolation rate Min/Inch
TYPE of SYSTEM:
Absorption field, otal leng h /200
Length of each tren, h `"i
Depth of trenches ' �g/.
Size of gravel
SEEPAGE PITS4Number .)f
Size- ft. X ,t.
Gravel size
PIPING: Sire Ty
Bldg. to tank
Tank to dist. box J
Dist. box to field/p'
Openings sealed? ( ES I NO Partial
c\-LOCATION/SEPARATIONS: //
Foundation to tank __ ft.
Foundation to absorp ion ` = ft.
Absorption to lot 1', e , df-ft.
Separation of pits ft.
LOCATION YSTEM .ON PRO'•ERTY(circle one)
Front - Rear Leff side Right side -
COMMENTS: i
SYSTEM US APPROVED Y NO
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.s.-2V4M OF QUEENSSURY
juN 1 8 1990
BLDG. & CODE DEPT.
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