1989-540 -i
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BUILDING PERMIT
TOWN OF QUEENSBUR'Y'
No. L19-540.
WARREN COUNTY, NEW YORK N
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PERMISSION is hereby granted to Theodore 7AC E �
OWNER of property located at �� vier S# rea t Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Saiwage 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
152 River Street
Queensbury , N . Y . 12804
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2. CONTRACTOR or BUILDER 'S Name -^„1
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Action Septic
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3_ CONTRACTOR or BUILDER'S Address
Glens Falls , N . Y . 12801
4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6. TYPE of Construction — (Please indicate by X) CD
{ } Wood Frame [ ) Masonry { ) Steel { } crr
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7. PLANS and .Specifications r+
No_ Existing tank , 135 ' Tile Field as per plot plan and application
B. Proposed Use
Sewage Alteration LIq
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$ 25 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES July 11 19 Al
(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 dare,) -g
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Dated at the Town of Queenshuryr 11 Ch Day of July 19 �
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SIGNED BY for the Town of Queensbury
Building and Zoh Ifig I nspector
TO OF QUE- El~ SBURY
APPLICATION FOR
> SEPTIC DISPOSAL PERMIT @� l I9,gy
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FAQ
DATE / I
LOCATION OF PROPERTY FOR INSTAL%tATION
Owner's Name: ,/i�G2{J � / Telephone* �t �
Address:
Installer's Name: Telephone:
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Number of bedrooms (residential only)
Total daily flow (compute (d 150 gal per bedroom) 67 Xo4e -e4.
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Topography: Circle one: , Iat Rolling Steep Slope % of Slope
,oil Nature: Circle on . San 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: lunicipal Well Other
If domestic water supply is a well:
Separation: Water supply ,#'roin septic absorption feet
PROPOSED SYSTEM : Septic T4ffKgal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench feet/Total system length / `?_5 feet
SEEPAGE PIT(S): Number orf�� / Size each feet by feet
Size of stone to be used # tom- /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
Supti. c System Inspections :
A . All applications for septic system installation , alteration or repair ,
as required by the Town of Queensbury Sanitary Sewage Ordinance , shall
by submittud to the Building Departmunt at least 24 hours before start
of construction and shall include a plot plan slGawing :
1 . ) the proposed location of the system
2 . ) location and distance to lot lines
3 . ) location and distance to structures
4 . ) location acid distance Co any water supply
5 . ) size and dimensions of all tanks , distribution boxes ,
rile fields and /or drywells
B , N system shall be covered before inspection and approval by the
1uilding I ,'spuctor . Failure to comply with this requirement may
1- U5ult in the uncovering; of the system by the installer and a fine
of eta to $ '' 50 . 00 .
0 - ALNI .approved copy of the plot plan shall be available on the construction
situ . Failure to produce said plot plan at time of inspection may
r-usult in an immudiace work stoppage .
D . Should unforeseen problems during construction prevent proper installa-
tion , alteration or rupuir of an approved system , a new proposal must
1' submitted CO the fQuuunsbury Building Department before further
c on:. truction .
Town of Queensbury
BUILDTNC and CODES DEPARTMENT
Bay and Haviland loads
Quuansbury , New York 12804
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BUILDING and ZONING DEPARTMENT
Bay and Haviland Road. R-D, I Box 98
Queenstwry. New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION
DATE / f� PERZMIT NO .
Sand - clay -
SOIL TYPE - NO
Fercolat n Test Required? YES
-�
Percolati rate Min/Inch -
TYPE of SYS a. :5Q
Absorption f i lde total length
Length of each trench
Depth of trench
Size of grave3: a of)
SEEPAGE PITS
Size- fto -- �-
size sl
Gr S Tipp
PIPING t
Bldgo to tank.
Tank to disc. box
Dist. box to field
Di O partial
Openings sealed .
LOCATION/SEPARATICNS : t4sc,-t NJ G
Foundation to tanks. -�_
Foundationto absorpti n ft.-}--
Absorption to lot lin ft.
Separation Of pits SYSTEM OP E (circle one)
LOCATION OF t side
r'� Sid - Rig
Front - R ar
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SYSTEM USE APPROVED n
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Bu 1 ing Inspe or
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A ctzan s eptic Sevice
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• oldo Shuw 's Septic Service
P.Q. Box 1430
Saratoga Road
South Glens Falls, N.Y. 12803
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793-2115 7934949 5874444
y�, Trott bleshooting Orer Specialty