1989-575 BUILDING PERMIT
TOWN OF QUEENSBURY
No- $9- 57 5
2 + � 2
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Betty Duffy ON
OWNER of property located at 106 Coolidge Avenue Street, Road or Ave.
in the "town of Queensbury, To Construct or place a — Sewage Alteration
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. a
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1. OWNER'S Address is
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Same
2. CONTRACTOR or BUILDER 'S Name
Sanitary Sewer
3. CONTRACTOR or BUILDER'S Address
Glens Falls , N . Y . 12801
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4. ARCHITECT'S Name c'
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5. ARCHITECT'S Address ru
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6. TYPE of Construction — (Please indicate by X)
{ ) Wood Frame { ) masonry { ) stool I T
7. PLANS and Specifications
No. 1000 gal . tank , 200 ' tile field as per plot plan , and application
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S. Proposed Use QC
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SEWAGE ALTERATION `
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$ 25 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES — July 21 19 91
(if a longer per!ad 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 1st Day of July 19 89
SIGNED BY for the Town of Queensbury
Building and 2oni nspector
TOWN OF QUEENSBURY
APPLICATION FOR TOWN OF QUELNS9URY
r -i--- RECEIVED
SEPTIC DISPOSAL PERA+ 4T
U L 2 0 1989
4` BLOG. & CODE. DEFT,
DATE ( � �
LOCATION OF PROPERTY FOR Ij}NSTALLATION ,I' 9 �'� ,��
Owner's Name: Cl ,. ,+ C Telephone :
Address: 20
Installer's Name: C Z Telephone :
Number of bedrooms (residential only)
Total daily flow (compute Cd 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 requir required rate min. inch.
Domestic water supply: circle on Nlunicipa Well Other
If domestic water supply is a wel :
Separation : Water supply from septic absorption feet
PROPOSED SYSTEM : Septic Tank / L7 a 4� gal. ( minimum size: 1 . 000 gal. )
TILE FIELD : Each Trench feet/Total system length d o feet
SEEPAGE PIT(S): Number of - / Size each feet by — feet
Size of stone to be used # _/Depth or Thickness ,/r feet
** **** * * ** **** ** ** ** **** *
I have read the regulation on the reverse side of s sheet and agree to abide by these
and all requirements of the flown of Queens y Sani ry Sewage P17bial Ordinance.
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SIGNATURE OF RESPONSIBLE PERSON:
DATE: •/ - / P ` F
OVER
Alm
Septic System 1nSpect ions
:
A . till applications for septic system installation , alteration or repair ,
as required by the Town Of Queensbury Sanitary Sewage Ordinance , shall
be submit-eed to the Building Department at least 24 hours before start
of construction and s !1all include a plot Plan snowing :
1 . ) the proposed location of the system
21 ) 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 ,
file fields and / or drywells
B . NLL system shall be covered before inspection and approval by the
Building Ijxsp,._ ctor . Failure to comply with this requirement may
1- + Sult in the uncoverins of th4 sysri,!m by the installer and a fine
: up to ; 250 . 00 .
C . An approved copy of the p10C plan shall be available on the construction
situ . 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 rtapair of an approved system , a new proposal must
k,� submitted to the Queensbury Building Department before further
co �i traction .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and 1laviland Roads
Queensbury , New York 12804
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_ .Jaurn o/ �eteen36eert� I _
eUILDING and ZONING DEPARTMENT
Bay and Haviiand Road, R. D. 1 Box 98
aueensbury, New York 12801
SEPTIC DISP L S TEM INSPECTION
NAME Ec
LOCATI
DATE I� PERMIT NO,
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES, Nd
Percolation rate - Min/Inch 7e
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TYPE of SYSTEM:
Absorption Field , total ttx
Length of each trench
Depth of trenches ' ,.
Size of gravel `
SEEPAGE PITS4N er of)
Size- ft. X
Gravel size
PIPING : S1 T
Bldg . to tank
Tank to dirt . x ;t
Distw box to field/ t
openings sea ed? Y S No Partial
LOCATION/S ARATIONS :
Foundation to tank Aj ft-
Foundatio to absorption fte
Absorptio to lot line �fte
Separati of pits ft.
OF SYSTEM ON PR[YPERTY (circle one)
Front - ear - Left side •• Right side -
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SYSTEM USE APPROVE S N
Bu in In p ctor
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