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1989-294 r YC BUILDING PERMIT � TOWN OF QUEENSBURY No. 99-294 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to �w Brent Bordeau OWNER of property located at 4fWb %sW_ Dixon 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. 1 . OWNER'S Address is SAME °c n� i 2. CONTRACTOR or BUI LDEWS Name C Y Reliable Sewer Service i 3. CONTRACTOR or BUtLDEWS Address 55 Bay Road Queensbury, M . Y . 12804 4, ARCHITECT'S Name C P+ 4 S. ARCHITECT'S Address C C 6. TYPE of Construction — (Please indicate by XI tf C ( 1 wood Frame ( I Masonry ( 1 Steel ( i 7. PLANS and Specifications No. Existing tank pump houses 2 8 ' x 8 ' seepage pits , as per plot plan and application 8. Proposed Use is Sewage Alteration " n $ S. B PERMIT FEE PAID — THIS PERMIT EXPIRES �lE Mal 10 19 of 4j c i (if a longer period is required an application for an extension must be made to the Building and Zoning inspector of the r town of Queensbury before the expiration date.) C r Dated at the Town of Queensbury this _ 10th Day of May 19 89 � SIGNED BY ` for the Town of Queensbury Building and Zoning nspecfok c APPLICATION FOR SEPTIC DISPOSAL P rO WN E�V�©NS&UA Y qd ` ` ^-� NAY 10 1989 DATE / SLOG. CODE CEP7- LOCATION OF PROPERTY FOR INSTALLATION Owner's Name•. .t'+� C47 ( " 13646 e..'"eK '[,,' Telephone= Address: erii 3 �SYDN /4�n.9t� Installer's Name : ,, 0�„ S;;?, t � Telephone: 0Z Number of bedrooms (residential only) =.2__-- Total daily flow (compute @ 150 gal per bedroom) Topography: circle one: lat Rolling Steep Slope % of slope Sail Nature: circle one: Sand Loam Clay other f Depth: feet +[wound. Water: At what depth? feet lUtdrock or Impervious Material: At what depth? �x._ feet Percolation test: circle one: not required required / rate ^ xnin. inch. Domestic water supply: circle one : Q9 unicipal Well Other IF domestic water supply is a Well: Separation: Watersupply from Septic absorption 7th feet PROPOSED SYSTEM : Septic Tank al.�{m niTILE FIELD: Each Trench. feet / Dial system lfeet 00 SEEPAGE PIT(S) : Number of — 2 / Size each _ �� feet by feet Size of stone to be used 4� y �� _ / Depth or Thickness? "� feet IMPORTANT ...Please...LIST NEW En QUIPMENT IrO BE INSIrALEED (over) r Section Il 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 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, tile 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 $Z50.00. 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 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 l3isposal Ordinance. r Signature of responsible person: Date : Town of Queensbury Building and Code Department ., Bay at Haviiand Road Queensbury, New York 12801 (518) 792-5832 , 1? , � , AA00ruD; CERTIFICATE ` SF INSURANCE NCE ISSUE DATE (MM/DDIYY) PRODUCER CERTIFICATE��irrr Y■ ■ �1�/ 5 / 1 0 / 8 9 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Community Insurance Agencies NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, PO Box 1 3 6 9 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW SO . Glens Falls , N . Y . 12803 COMPANIES AFFORDING COVERAGE COMPANY CODE SUB-CODE LETTER A United States Fidelity & Guaranty Co . I COMPANY g INSURED LETTER Carl R . Dingman dba COMPANY Reliable Sewer Service LETTER C PO BOX 1 7 S COMPANY Glens Falls , N . Y . 12803 LETTER O COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL L(MITS IN THOUSANDS I.TR DATE (MM)DDIVY) DATE (MM(DDIYY) GENERAL LIABILITY GENERAL AGGREGATE '$ 500 A X COMMERCIAL GENERAL LIABILITY ] C G 1 1 7 0 8 1 4 3 7 00 4 / 1 6 / 8 9 4 / 1 6 f 9 0 PRODOCTS-COMPIOPS AGGREGATE $ 5 0 0 CLAIMS MADE OCCUR. PERSONAL PERSONAL & ADVERTISING INJURY $ 300 OWNERS & CONTRACTOR'S PROT EACH OCCURRENCE $ 300 FIRE DAMAGE (Any one fire) $ 50 MEDICAL EXPENSE (Any one person) $ 5 AUTOMOBILE LIABILITY COMBINED A ANY AUTO Unassigned 4 / 16 / 89 4 / 16 / 90 SINGLE $ 300 LIMIT ALL OWNER AUTOS BODILY X SCHEDULED AUTOS GIs 7Y INJURY (Per person) HIRED AUTOS BODILY NON-OWNED AUTOS INJURY $ (Per accident) GARAGE LIABILITY PROPERTY $ DAMAGE EXCESS LIABILITY EACH AGGREGATE OCCURRENCE $ $ OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY AND S ; 0 f0- {EACH ACCIDENTy EMPLOYERS' LIABILITY Unassigned 5 / 1 0 / 8 9 5 / 1 0 / 9 0 $ 500 (DISEASE—POLICY LIMIT) XT.9@BRIf Vehicles : $ 1 0 0 (DISEASE—EACH EMPLOYEE 88 Dodge 1B7KW24503S6 ? 7171 78 Dump R70BVBB1476 80 John Deere Backhoe 310AD344818T " DESCRIPTION OF OPERATIONSJLOCATIONSIVEHICLES!RESTRICTIONS/SPECIAL ITEMS Septic Tanks & Installation CERTIFICATE HOLDER TM -_� CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of Q u e e n s b u r y EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL I 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25-S (3/88) OACORO CORPORATION 1088 �lcrwn o� �ueenshurr�t BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D} 1 Box 98 OueensDury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME /BQ ���f LOCATION DATE PERMIT NO ._k - 94 SOIL TYPE - Sand - Loam - .Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM : Absorption field , total length Length of each trench Depth of trenches Size of gravel_ SEEPAGE PITS4Number of) Size- ft. X ft . Gravel size - f PIPING : Size Type Bldg . to tank 1 Tank to disc . box Dist , box to field/pit Openings sealed? YES NO Partial LOCATION/SEPARATIONS : Foundation to tank ft. Foundation to absorpti n ft . Absorption to lot lin ft . l Separation of pits ft . LOCATION OF SYSTEM PROPERTY (circle one ) Front - Rear - Left side - Right side - COMMENTS Lo S c crs + ["�— SYSTEM USE APPROVED Yo NO Bui n ector g 01/86 and v1 l _._J'OW 01 Queens �ur� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R ,0. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME F Q CZ � V s - LOCATION 2, A 431 XM AI DATE PERMIT NO . SOIL TYPE Sand - Loam - Clay Percolation st Required? YESTt,�,i Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field., total length Length of each �,.,�....� Depth c es of gravel , "�� SEEPAGE PITS#Number cif) Size- -!Fr ft. X 'fto Gravel size -,, ,► _ _ PIPING : Size Type Bldgm to tank FUMIP"Wk to dist . 13 X Disto box to fAeld/pit openings sealod? Y8S NO Partial LOCATION/SE�ARA.TIONS : Foundation/to tank ft. Foundatia to absorptioD ZD ft.. Absorpti to lot line r ' ft � Separatiobn of pits to LOCATICIq OF SYSTEM ON PROPERTY (circle one) ro Rear - Left side - Right side C0A4 PI-k7* Y:>. , rc , crs & �AA JV"a f 9900M USE APPROVED Ea NO /7 LZ Bu lding Spector 01/86 and vl C ° d