1990-174 BUILDING PERMIT y
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TOWN OF QUEENSBURY No. 90-174
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to WAYNE LA LONT)E
OWNER of property located at ? Dixon Rd 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 - 0
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same
2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer z
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3. CONTRACTOR or BUILDER'S Address
PO Box 224
Glens Falls NY 12801
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( )
7. PLANS and Specifications
Sewage alteration:
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No. 10 00 gal. Tank with _one'10'-x 8' seepage pit with #3 stone at 2' depth
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as per application and specifications. ro
8. Proposed Use
Sewage alteration I
$ 25.00 92
PERMIT FEE PAID —THIS PERMIT EXPIRES April 18 19
(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.)
Dated at the Town of Queensbury this 18th Day of A ril 1990
SIGNED BY (207 for the Town of Queensbury
Building and Zoning I spector
TOWN OF QUE NSfURY
APPLICATION FOR
SEPTIC DISPOSAL PERMIT y °, =''' ?_''r
/ APR 17 1990
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BLDG. & CODE DEPT.
DATE apart J / 7 ' / d
LOCATION OF PROPERTY FOR NSTALLATION
Owner's Name: A4 1( , L y - / -- Telephone:
Address: 1 � �1 `f G/0 �J
Installer's Name: Q LA P e !JS � w ✓ Telephone: .?
Number of bedrooms (residential only) Z.,
Total daily flow (compute (. 150 gal per bedroom)
Topography: Circle one: lat Rolling Steep Slope % of Slope
Soil Nature: Circle one: an 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:`'Runicip� Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption feet
PROPOSED SYSTEM: Septic Tank 7 `) gal. (minimum size: 1.000 gal.)
TILE FIELD: Each Trench feet/Total.system length feet
SEEPAGE PIT(S): Number of f / Size each/a feet by >7' feet
Size of stone to be used # /Depth or Thickness 2 feet
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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 Queens y Sanitary Sewage Disp sal Ordinance.
SIGNATURE OF RESPONSIBLE PERSON:
DATE: 2/i
OVER
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Septic System Inspections: •
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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 $250.00.
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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.
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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
construction.
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Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
'Queensbury, New York 12804
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Rumarks : .
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awn o/ Queenilury
• BUILDING and ZONING DEPARTMENT •
Bay and Haviland Road, R.D. 1 Box 98 .
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSP'CTION
NAME IV./10,"_
LOCATION ''''. WNW
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DATE »}� /20 PERMIT NO. U' r
SOIL TYPE Sa .t) - Loam - • ay -
Percolation Test Required? YES - NO
Percolation rate - Min/In.
TYPE of SYSTEM: \
Absorption field, total 'ength
Length of each tre ch ' .
Depth of trenches "
Size of gravel \ I _
SEEPAGE PITS{Number1of) ' y,w /
Size- g ft. X b t,: ,7 ,c i
Gravel size , '4 f
PIPING: .Size , Type
Bldg. to tank ��
Tank to dist. box �` PAC
Dist. box to field/pi
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Openings sealed? S) NO Partial
LOCATION/SEPARATIO.S:
Foundation to tan 5 ft.
Foundation to abs!yrption ft.
Absorption to to line ft.
Separation of pi s \ ft.
LOCATION OF SYS !_ _ON_PtPOPERTY(circle one)
Front - Rear-= eft side - R ,ght side -
COMMENTS: •
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SYSTEM U.E APPROVED YES NO \
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BLDG & CODE DEPT.
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