1989-235 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 89-235
WARREN COUNTY, NEW YORK u
PERMISSION is hereby granted to HAROL.D KROLL G
OWNER of property located at 46 Cottage Hill Road 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-
T. OWNER'S Address is
T
Same
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2. CONTRACTOR or BUILDER 'S Name
Queensbury Sewer
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3. CONTRACTOR or BUILDER'S Address
RD#1 Upper Bay Road
Lake George , N . Y _ 12845
4. ARCHITECT'S Name o
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S. ARCHITECT'S Address tC
S. TYPE of Construction — (Please indicate by X)
( 1 Wood Frame f ) Masonry [ I Steel 4 } C
7. PLANS and Specifications
No. Existing 1000 gal . tank , 150 ft_ the field as per plot plan and
application _
8. Proposed Use
Sewage Alteration
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$ 25_ 00 PERMIT FEE PAID — THIS PERMIT EXPIRES November 1 1989 x
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(If a longer preriad is required an appliartion for an extension must be made to the 8uildira.7 and Zoning inspector of the fC
town of (lueensbury before the axpi rat ion date.,}
Dated at the Town of Queensbury this 25th pay of April 19 89
SIGNED BY for the Town of Queensbury
Building and Zoning Ins or
40f 01teend&a*34 TC3WIV OF
FREC 3V
APPLICA0190N FOR SEPTIC DISPOSAL PERMIT •�•••`�••�••••
& DIN OWES ID
APR 2 G WM Of +CWEFJ�SDUR Y
BLDG. & CODE DEFT
DATE
LOCATION OF PROP R TY FOR 1NSTA,L.LATIOU
Owner's Name : HC � Telephone:
Address: Xxc� Co_ L
Installer's Nam Telephone: o2 36
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom ) 3
Topography: circle one: Rolling Steep Slope i6 of slope
Soil Nature:: circle ❑txe: Csand Loath Clay Other / Depth: feet
Ground Water: At what depth? feet
Bedrock or laupa.rvious Material: At what depth? feet
Percol..xtioia teat: circle one: required / rate min. inch.
Donsestic water supply: circle one: unrC pa Well Other '
I1� domestic welter supply is a Well:
Separation: Watert;upply from Septic absorption . feet
PROPOSED SYSTEM : Septic Tan�r ��ar gal. (minimum size: 1 ,000 gal.)
"tILIr MELD : Each Trench �4 feet / Total system length feet
SEEPAGE PIT(5) : Number of / Size cash feet by feet
Size of atones to Ue: used IF 2L _ / Depth or Thickness r'� or�_ feet
IMP0ItTANor
_._Please...LIST NEW EQUIPMENT '170 13H INSTALLLI3
Section II Septic System. Inspections:
A. All applications for septic system installation. alteration or repair, as
recfuii . d by the 'Town of Queensbury Sanitary Sewage Ordinance, shall
lae submitted to the Building Department at least 24 hours before start
Of cu"btruction and shall include a I-slot plan showing:
I .) 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.) site and dimensions of all tanks, distribution
boxes, the fields and/or drywells
B. 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 $250.00.
Co An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at tine of inspection may result
in an immediate work stoppage,
Do Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system , a new proposal must be submitted
to the Queensbury Building Department before further construction.
I have read the regulations above and agree to abide by these and all requirements
of the 'Town of Queensbury Sanitary�Sewage Dia-poslzd. iziance. )
Signature of responsible person : `
n
13aLc:
Town of Queensbury
Building and Code Department
Flay at Haviland !-toad
Que-ensbury, New `fork 12801
( 518) 792--5832
I IL -let ,
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road. R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION '. v
DA'1'E �I-I� 1 PERMIT NO -
SOIL TYPE Sand Loam Clay
Percolation Test Re ? YES N
Percolation rate - Min/Inch
TYPE Of SYST
1
Absorption £ie r
total leng ! ��
Length of each ench -+r
Depth of trenche
Size of gravel_ !
SEEPAGE PITS*Nb use f .
Size- 0 --
Gr size Type
Size
PIPING :
Bldg . to tank
*Tank to dieto box c
Dist. box to fie d/fie NO
Partial
openings sealed �•S�
LOCATION/SEPA TIONS
Foundation t tank 2,6� ftL- f -
Foundation absorption t .
Absorption o lot line
C7
Separation o£ pits pgOPERTY ( ircle one]
LOCATION SYSTEM 17N side
nt ^ R ar - Left side ^ Ri.gh f
NTS -
SYSTEM USE AP"DVED YE
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Building Inspe for
Ql/86 and vl
lit
Ii1 UE�DATE/� B(M..t�rU�CC;Y._` �)
_ L J
PRODUCER s
"
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
McCarty / Rourke NO RIGHTS UPON: THE CERTIFICATE HOLDER. THIS CERTIFICATE DOTS NOT Amr-NO
1 Saratoga A E EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ULILOW.
So . Glens Falls , NY 12803 COMPANIES AFFORDING COVERAGE
E COMPANY
LETTERState, I ns Fund
j
"•`` COMPANY k
:ls;_. IrrSURa:D LETTER ' 4
Jason A . Sweet DSA COMPANY
Queensibury 'Sewer LETTER CF_.Irst Central zns Company
R D . # 1 , Bay R d . COMPANY ID —�
Lake George , NY 12845 LETTER '
COMPANY
LETTER
i
�jqoun�. i,gaiim
•THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO ThE INSURED NAMED ABOVE FOR THE POLICY PERIDDINOICATED. f'
NOTWITHSTANDING ANY REQUIREMENT, TERM 1DR CONDITION OF ANY CONTRACT Ors OTFrER DOCUMENT WITH RESPECT T'O WHiCH THIS CERTIFICATE MAY
BE ISSUED OR MAY PERTAIN, THE INSURANCE. AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI. P
' TIONS OF SUCH POLICIES.
CO LIABILITY LIMITS 1N THOUSANDS
TYPE OF INSURANCE POLICY NUTA8ER G'I)I ICr a"{PF[', _ ___
a POLICI' E%r'IFU7:GPi
' LTR Izi[I FM1[r.L'UCi,'T}1 UAIE ih3f"L'i101YY1 ...."-.. .... .� �-I'.gCrl AIi G}iE C:A1E
GENERAL LIABILITY 441711 v
_ COMPREHENSIVE R1gM Ix_lu{.Y $ `
1 PREMISESIOPERATIONS P`
UNDERGROUND RROF'tH1Y
EXPLOSION 5 COLLAPSE HAZARD oAMAUi_ _
PRODUCTS,'COMPLETED OPERATIONS
CONTRACTUAL 41 a PD
l'.QI.4I51r:E17 ^It
INDEPENDENT CONTRACTORS
611114D FORM PROPERTY OAMAGF
PERSONAL INJURY PERSONAL INJURY $
S
AUTOMOBILE LIABILITY
ANY AUTO ' .. r rIr:.ukir $ inn
�,.
X X ALL DYPNEO AUTOS [PRiV. PASS.; AR 3 O 3 1 2 - O 2 ' 8 / 8 / 8 8 8 / 8 / 8 9
C ALL OWNED AUTOS !OTHER THAN) �r.,.,ar � �
1 PRIV. PASS .rta .N;c.14 [I $r i'
HIRED AUTOS
r'ki(ay c{i1Y "
NOWOWNED AUTOS UI MA"E $5 d
GARAGE LIA["'Ll Y
III fA Pil
T EXCESS LIA6iLl7Y _—.._--
Ur>ndRELLA IL115M C'r31 PU QQ L
UMI31r4EL W I '
OTHER THAN UPRBRELLA Fit{;I.I I _ �i', .
a T.a.SUTI�TiY --
WOFiKER$' COMPENSATION --• -;---- --- _ ,
AND 1,.Q � it ACl1 Ak`CIULN II _ -
EMPLOYEFr$' LIABILITY $ {Gj:;i: I''i Er_p }I_IL:Y LIMITI
A S $ 28417 - 6 5 / 22 / 88 5 / 22 / 89 ;U, EAvE-EICHEI44PLC}YEF}
I. rlOTHER _ 4.
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_B 4 .1 i t y .---._ _ ,-2_€'4� L5� _.__4/ 2_�'/ --Csix I. 1 n u�_ s--- S_t�tt l-tQ�
UFSCRIPTION OF OrPERATIONSILCC.:.TkONS!VFHICLE:!F'PCCIAL ITEPAS
Septic Services & Operations incidental thereto
I.iJ44' `.�. : .. - - . . . . .
T Yl E' Town IJ 'F Q U E? n S }:7 U r .�.f SHOULD ANY OF THE ABOVE DESCRII3ED POLICIES BE CANCELLED BEFOFIE TtiE L X
y PIRATI,ON DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO i
Q u e e n s b u r y , NY 12804 MAIL 10 DAYS WTUTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE s
] LEFT, BUT FAiLQF'L4 TO MAIL SUCH NOTICE SHnLL iMPGtaE NO OBLIGATkOIJ OR LIABILITY
OF ANY KIND UPON THE COMPANY , ITS AGENTS OR REPHESFNTATIVES.
AU TrtC iiZED F-sEi-/�"i�sE Sf�fN^"�EATlVE
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