1989-342 BUILDING PERMIT
TOWN OF QUEENSBURY" o
No_ _ 89_ 342
WARREN COUNTY, NEW YORK
PERMISSION is hereby
granted to Joe (t'e72111 d
OWNER of property located at 16 Bonnipr Drive 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 �7
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. N
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1. OWNER'S Address is •`"�
SAW
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2. CONTRACTOR or BUILDERS Name
Action Septic Service
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name pQp
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S. ARCHITECT'S Address
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6_ TYPE of Construction — {Please indicate by x}
I Wood Frame I ) Masonry I ) steel I t
7. PLANS and Specifications
No. Existing 1000 gal . tank , 200 ' the field as per plot plan and
application . �n
S. Proposed Use z
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Sewage Alteration I'°
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$ 25j 00 PERMIT FEE PAID --- THIS PERMIT EXPIRES may 22 19 91
(If a longer period is required an application for an extension must be made to the 8uildi
PP ng and Zoning inspector of
town of Gu eensbu ry before the expiration date_)
Dated at the Town of Queensbury th" 22nd Da f May 1989
SIGNED BY for the Town of Queensbury
Building and oni rrg I nspector
TOWN of QUE- ENSBURy 0A 0--
APPLICATION FOR F UEENSBURY
WN O Q
x SEPTIC DISPOSAL PERMIT RECEDED
MAY ry t; 1989
BLDG. & CODE DEPT.
DATE
LOCATION OF PROPERTY FOR INSTALLATION y
Owner's Name: 0& .O�' ,Z fir/�Q ,Telephone: GJ _
--------7t
Address:
Installer's Name: C.c7 .1 f•"",• p, Telephone:
Number of bedrooms (residential only)
Total daily flow (compute (d 150 gal per bedroom)
Topography: Circle one• Flat Rolling Steep Slope e
Soil Nature: Circle one: ar Loam Clay Other /Depth: Feet
Ground Water: At what depth? Feet
Bedrock or Impervious Material: At what depth? Feet
Percolation test: Circle one: not required required rate min. inch.
Domestic water supply: circle one: unicipal Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
Axrf
PROPOSED SYSTEM: Septic Tank../Pod 61 F gal. ( minimum size: 1 , 000 gal.)
TILE FIELD: Each Trench 5-0 feet/Total system length JWe feet
SEEPAGE PIT{S): Number of / Size each 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 Ordinance,
SIGNATURE OF RESPONSIBLE PERSON:
DATE :
OVER
Se }atic System inspections :
A . All applications for septic system installation , alteration or repair ,
as required by the Town of Queensbury Sanitary Sewage Ordinance . shall
bu submitted to the Building Department at least 24 hours before start
of construction and slit-ill 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
S . ) size and dimensions of all tanks , distribution boxes ,
tilu fields and /or drywells
B , No system shall be covered before inspection and approval by the
i: uilding Inspector , Failure to comply with this requirement may
r- . sult in the uncoverint; of the system by the installer and a fine
of sap to $ 25Q . 004
C , An :approved copy of the plot plan shall be available on the construction
sits! , 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
tau submitted to the Quksunsbury Building Department before further
Cosaat rue tion ,
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
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BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 88
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME c ice. Z Z U L Ca
LOCAT�Io/N
DATE - , Z PERMIT We
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorptionx field , total lervqth G +�
Length of each trench
Depth of trerthes.
size of gravpj
SEEPAGE PITS+1r7 per of) .`—
Size- fte X - ft . '
Gravel size
PIPING : Size Type
Bldg * to tank ��
Tank to dist. box � �-
Dist. box to field/ t LG^
openings sealed? ;` `s NO Partial
LOCATION/SEPAVATIONS :
Foundation to tank t'.'Er S / f't.
Foundation to absorption t -
Absorption to lot line t-
Separation of Pits f
LOCATION 'SYSTEM ON PROPERTY (ci F1e one)
Front -
- ea left side - Right side -
CGMNSENT /
74
SYSTEM USE APPROVED YES NC,p�
Bull ing Inspector
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'I �►FR Action Se tic Service
Shaw 's Septic Service
P.O. Boar 1430
Saratoga Road
South Glens Falls$ N.Y. 12803
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793-2115 793-4949 5874444
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