1989-216 BUILDING PERMIT
TOWN OF QUEENSBURY "
No. 89-216
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Kleth Laake
OWNER of property located at 28 Bonner Drive Street, Road or Ave. r
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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.
1. OWNEWS Address is
Same
2, CONTRACTOR or BUILDER 'S Name
Action Septic Service
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3. CONTRACTOR or BUILDER'S Address M
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a_ ARCHITECT'S Name
5. ARCHITECT'S Address
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6, TYPE of Construction — {Please indicate by XI
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) Wood Frame i f Masonry i I Steel I I I
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i, PLANS and Specifications
N,, l000 gal . existingtank , 2 6 ' x$ ' seepage pits as per plot
plan and application . 1
8. Proposed Use
Sewage Alteration
$ 25 a OQ PERMIT FEE PAID — THIS PERMIT EXPIRES November 1 19 89
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Ousensbury before the expiration date.)
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Dated at the Town of Queensbury t th Day of A P 1989 �
SIGNED BY for the Town of Queensbury
Building and ZcFning Inspector
� a
TOWN OF Q UEEN'S B UR Y rownt F c�vl;Er�sBURy
RECEIVED
APPLICATION FOR
P R
=-v � SEPTIC DISPOSAL PERMIT
TOWN F R � �- � � � � ►� UPEXD(3m Coro
E DEM
UILD11a-I G DEFT.
,,�r / - / r pt REVIEED BY
DATE .�'?�I fir! Gt ��/ `! 0 W
/
DATE
LOCATION OF PROPERTY FOR INSTALLATION 4>2
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Owner's Name: -�} ? /c - (�' Telephone:
Address:
7 .1
Installer's Name: - �f�% af C Telephone:
Number of bedrooms (residential only)
Total daily flow (compute (d 150 gal per bedroom) y 5Q
Topography: Circle one: Flat Rolling Steep Slope % of Slope 4egt
Soil Nature: Circle one: Sand Loam Clay Other. /DTepth: Feet
Ground Water : At what depth? Feet
Bedrock or Impervious Material: At what depth ? Feet
Percolation test: Circle one: 6ot 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
ez A K,q
PROPOSED SYSTEM : Septic 'rank ,4 00 gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of t;' ., / Size each e feet
by feet
Size of stone to be used #_ /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 Ord)fiance*
SIGNATURE OF RESPONSIBLE PERSON :
r
DATE:
OVER.
Septic System Inspections :
A. , All applications for septic system installation
as required by the Town of Queensbury Sanitary Sewage alterOrdinallce , shall
bu submitted to the Building Department at least 24 hours before start
of construction and shall include a plat 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 ,
tile fields and /or drywells
B , No System sha11 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
cat 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
o submitted to the Queensbury Building Department before further
construction .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
R. ruarks ;
flown of Q"eenjt "rry
BUILDING and ZONING DEPARTMENT
Bay and Naviland Road, R.D . I SOX 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM ,INSPECTION
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NAME,
_
LOCATION 45se
DATE _ PERMIT NO ._ " �/ /�
SOIL TYPE Sand - Lorin - Clay -
percolation Test Required? YES
Percolation rate - Min/Inch
TYPE o SYSTEM:
Absorpt n field , total � y�
Length a each
Depth of nches
Size o gr ve T .�
SEEPAGE 'PIT laumber of) -
Size^ ft X
Gravel size Siz Type
PIPING *
Blago to tank
Tank to dirt. bo _
Distw box to fi.el P partial
Openings sealed? S NO
LOCATION/SEPARATI S . '� T-
�
Foundation to t k Lam- ft . —
Foundation to sorpti
Absorption to of line r Separation ft:fi-
o pits
LOCATION OF YSTEM ON PR ERTY (ci.rcle one)
Rs - Left side Right side -
CGMMENTS
SYSTEM USE APPRfYVED Y NO
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BuilBing Inspe or
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RoorFR cttoa Se■j/y//y)t�c Service.
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� M, S1'iaw's Septic Service
P.O.Box 1430
Saratoga Road
South Glens Falls,N.X.12803
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793-2115 • 793-4949 - 587-4444
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