1988-652 BUILDING PERMIT
TOWN OF QUEENSBURY No.
88-652
WARREN COUNTY, NEW YORK .b
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PERMISSION is hereby granted to John Winslow
OWNER of property located at LUzerne Rd. & � in Ave_ Street, Road or Ave.
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
Box 169 LUzerne Road
Glens Falls, N.Y. 12801
2. CONTRACTOR or BUILDER'S Name p
Sanitary Sewwer Service
3. CONTRACTOR or BUILDER'S Address
P.O. Box 25
Glens Falls, N.Y. 12801
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) p
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( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
No. 1000 gal. tank, distribution box and 200' leach field as per
plot plan and application
8. Proposed Use
sewage alteration
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10.00 w
$ PERMIT FEE PAID —THIS PERMIT EXPIRES August 1 19 90 r~i
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(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.)
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Dated at the Town of Queensbury thi 29th Day of August .- 19 88 0
SIGNED BY 4 for the Town of Queensbury
Building and Zoning In pector
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APPLICATION FOR SEPTIC DISPOSAL PERMIT WING t b1tXl COOLS ULPM.
•�—� 'UN Of Ouwaulrr
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LOCATION Ol PROPERTY.FOR INSTALLATION
Owner's Name: TOAitl %/+icS GJc,..) Telephone: _7 9.7— P/ 39"
Address: kcv?.._ /c 9 A(> ur
g ce �c7iLAfele_ A62_e.ca!-e Go,J'c
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Installer's Name: j �,C� [yA,c�c .5 C�wc,� _ Telephone: 7 9 2 ' 701
Number of bedrooms (residential only) —
Total daily flow (compute e 150 gal per bedroom) ^ Z(.5—v
Topography: circle one• .la Rolling Steep Slope % of slope
Soil Nature: circle one: San • Loam Clay Other / Depth: feet •
Ground Water: At what depth? feet
liedrock or.luwpervious Material: At what depth? feet
Percolation test: circle one: of require required / rate min. inch.
Domestic water supply: circle one: uire ► Well Other
. 1F domestic water supply is a Well:
Separation: Watersupply froth Septic absorption _ feet
PROPOSED SYSTEM: Septic Tank /0 dp gal. (minimum size: 1,000 gal.)
TILE FIELD: Each Trench Lto feet / Total system length 4-6 feet
SEEPAGE PIT(S): Number of / Size each feet 11y feet
Size of stone to be used ll / Depth or Thickness / feet
• • s • s * * * * • Y .• s • 4 4 4 4 4 4 4 4 4 * * * * * * i • 4 • * 4 4 4 4 4 4 4
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IMPOItTANI' •
...Pleas...LIST NEW 1:QUiPMLNT TO IiE INSTALLED
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Section II 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 1p,the Building .lieparin►eut at least 1.4 hours before start
of cuusu•uct►on and shall include a plot plan showing: •
' 1.) the proposed location•of the system •
Z.) location and distance to lot lines • - •
3.) location and distance to structures
•l.) 'location and distance to any water supply •
5.) size and diti►unsions of all tanks, distribution _ •
• boxes, the fields and/or.drywells
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l3. 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 x:.50.U0.
C. An :approved,copy of the plot plan shall be available on the construction -
site. Failure to produce,said plot plan at tinie of inspection may result
in an immediate work.stoppage. - •
D. Should unforeseen problems during construction prevent proper installation, •
alteration or repair of an approved system, a new proposal must be submitted
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to the Queensbury Building Department before further construction.
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1 have read the regulations above and agree to abide by these'and all requirements
of the Town of Queensbury Salait Sewa a Disposal Onlinanc •
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.Signature o1' responsible person:
--- Date: -? 9F
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Town of Queensbury
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Building and Cpde_Aep:►rtment
' . limy at.Ilaviland Road
Queensbury, New York 12601
(518) 792-5832
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..awn o/ Queeniu9,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Atm •
Queensbury, New York 12801
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SEPTIC DISPOSAL SYSTEM INSPECTION
NAME •
LOCATION / -GC42,7,(„'l / ,
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DATE j'`3)/ PERMIT NO. % k5e9
SOIL TYPE - and - Loam - Clay -
Percolation - t Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorptio field, total length .2z'
Length of -ach• trench [ �
Depth of tr: ches (;2/
Size of gray- A •
SEEPAGE PITS{ .er of)
Size- ft. ft.
Gravel size
PIPING: S.ze Type
Bldg. to tank •
Tank to dist. box ii
Dist. box to field/. ' c/
Openings sealed? YE. NO: Partial
LOCATION/SEPARATION : •
Foundation to tank , ft.
Foundation to absorption ft.
Absorption to lot Aine ft.
Separation of pits ' `ft.
LOCATION OF SYSTEM ON' PROPERIO(circle one)
Front Left side - Right side -
COMMEN' ":
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SYSTEM USE APPROVED ES N
B i i Ins ec
01/86 and vl
SANITARY SEWER SERVICE
Division of G. P. Drellos, Inc.
53 FOURTH STREET GLENS FALLS, N.Y. 12801
TELEPHONE 792-7257
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