89-923 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 89-923
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to BARBARA ORMIN
03
OWNER of property located at Moon Hi 11 Road Street,Road or Ave.
in the Town of Queensbury,To Construct orplace 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
7 Lent Court - APT. #5 O
Schenctadv, NY 12306
2. CONTRACTOR or BUILDER'S Name
co
Robert Lent
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3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) 0
0
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. Existing 1000 gal tank with 50' trench and 200' system/
8. Proposed Use N
SC
Sewage Alteration. m
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$ 25.00 PERMIT FEE PAID—THIS PERMIT EXPIRES November 22 1991
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the "I
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury t ' 22nd D of November 19 89
SIGNED BY / ' for the Town of Queensbury
uildingan ning Inspector
..)wiv (-Jr widizzlN.)LiU1tY X
;c�_ APPLICATION FOR L.
v. > SEPTIC DISPOSAL PERMITvA O
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LOCATION OF PROPERTY FOR INSTALLATION k6:7)/t-)234‘41- -
Owner's Name: ��3/c,c�H /2/1 CE/Q/72L ti' Telephone: , _----/ -'' - �,,��S -7 F'/
11
Address: / /�'%C -0 dy 4 ).y. A-2-706
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Installer's Name: r 0 ,4�',(?i :-A-'% Telephone:��/ -,5,5-�� -/?`7�
Number of bedrooms (residential only) ,---
Total daily flow (compute Cd 150 gal per bedroom) 1 5 C)
Topography: Circle on Flat 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? /F /1/6' Feet .
Percolation test: Circle one: not required required rate min. inch.
Domestic water supply: circle one: Municipal Neil' Other
If domestic water supply is a well:
Separation: Water supply from septic absorption `. <- feet
PROPOSED SYSTEM: Septic Tank / (:l'1 gal. (minimum size: 1.000 gal.)
TILE FIELD: Each Trench h feet/Total system length •I Pc feet
SEEPAGE PIT(S): Number of / Size each feet by feet
Size of stone to be used # /Depth or Thickness / f�.� 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 QueensbuCa
itary Sew ge Dis o Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: ���-- {--- I)
1 _ t ij----
DATE: ///. % e7
OVER
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UNALfTI ONIZED ALTERATION OR ADDITION TO C 1988
'MIS DOCUMENT IS A VIOLATION Of SECTION
il08 SUBDIVISION 2 OF THE NEW NORK STATE C.T. MALE ASSOCIATES,P.C.
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71/•11/ Pltore'SED ,& TIC V/ST6PA RE4OCATED C.T.MALE ASSOCIATES, P.C. ®®a
65 Boy Street,PO.Box 533 Glens Folls,NX 12801
(518) 7 L-7802 a)
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APPr.by: PC1.4.02 X n1ct,/..Q„ Proj. NO.87.5 85 _SCALE: I" = 501 JDATE: SEPT.7,1466