1989-315 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 89- a] 5 c
WARREN COUNTY, NEW YORK
1 N
PERMISSION is hereby granted to NORTi-IMIINDS MOBILE PARK w
OWNER of property located at 155 LUZERNE ROAD Street, Road or Ave.
in the Town of Queensbury, To Construct or place a SRNMERK 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.
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1. aNiR E 6Af4f&V.a is
P . O. BOX M 224
QUEENSBVRY , N . Y . 12804
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2. CONTRACTOR or BUI LDE WS Name 3
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SELF
ry
3. CONTRACTOR or BUI LOE R'S Address tuu
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SAME
4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction — (Please indicate by X)
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{ ) Wood Frame { 1 Masonry { I Steel { I
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Cl)
7. PLANS and Specifications
No. 1000 gal tank , 2 6 ' x 8 ' seepage pits as per PIN1 PRNK application . a
8. Proposed Use
Sewage Alteration
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$ 26000
PERMIT FEE PAID -- THIS PERMIT EXPIRES Decert6er 1 19�— ego
(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 this �15th Day of May 19 9aa t-r
SIGNED BY for the Town of Queensbury
Building4rYd Zoning Inspector
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APPLICATION FOR
SEPTIC DISPQSAL PERMIT TOWN OF QUEENSBURY
RECEIVED
/ �^- - MAY 1511989
DATE / ` T - GP BLDG. & CODE DEPT.
LOCATION OF OPERTY FOR INSTALLATION LJ ( J lA.! Q(t, " I 06 rCe �.
Owner's Name. (,.] Fd, c . F-kO fl 0 f�Telephone: 7 99
Address:
installers flame: t 7;.0 f, Telephone: / '' .2S
Number of bedrooms (residential onlyt
Total daily flow (compute Cd 150 gal per bedroom )
Topography. Circle one: Flat Rolling Steep Slope of Slope
Soil Nature: Circle onefw Sand Loam Clay Other /Depth: Feet
Ground Water: At what depth ? ,� - Feet
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle one; W required equired rate min. inch.
f
Domestic water supply: circle one- unicipal Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank 06 k�- gal. ( minimum size: 1 , 000 gal. )
TILE FIELD: Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number of i� W/ Size each feet by feet
Size of stone to be used #,/Depth or Thickness - feet
I have read the regulation on the reverse rnsb
e of th sheet and agre to abide by these
and all requirements of the Town of C�ru y Sa itary Sewag WISP 1 Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
DATE : c l
OVER
Septic System Inspections :
Ao All applic4ctions 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 Clio 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 ,
the fields and / or drywells
B . No -system shall be covered before inspection and approval by the
lsuilding 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 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
be submitted to the Queensbury Building Department before further
ccaczstruction .
Town of Queensbury
BUTLDTNG and CODES DEPARTMENT
Say and Haviland Roads
Queensbury , New York 12804
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BUILDING and ZONING DEPARTMENT
Bay and Mavifand Road. R.D. 1 Box 98
Queensbury, New York 12801
SE TIC I OSAL SYSTEM INSPECTION
NAME '"t'�"'
LOCATION ` A+
DATE I PERMIT NO.��/
SOIL TYPE - and Loam - Clay -
Percolation Tes Required? YES -
Percolation rate - Min/Inch -
TYPE of SYSTEM:
Absorption field , tal length
Length of each tren h
Depth of trenches
Size of gravel:_
SEEPAGE P ITS-#Number o
Size- --42.ft- X ft
Gravel size
PIPING : S1 a Ty e
Bldg . to tank
Tank to dirt. box
Dist* box to field
openings sealed? YES 40 Partial
LOCATION/SEPARATIONS : "4Wf t.
Foundation to tank HIV
Foundation to absorption ft .
Absorption to lot line
Separation pits ft.
LX)CATI F S TEM ON PROP TY (circle one)
Front - Rear ;- Left side - Right side COMMENTS :
SYSTEM 'USE APPROVED Y S NO
t
Bu ' lding Tnsp ctor
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