1987-259 BUILDING PERMIT
TOWN OF QUEENSBURY No, 87-259
WARREN COUNTY, NEW YOR K
PERMISSION is hereby granted to John Moynihan
OWNER of property located at 18 Buena Vista Avenue Street, Road or Ave.
Sewage Alteration 0
in the Town of Queensbury, To Construct or place a
at the above location in accordance to application together with plot plans and other information hereto filed and o
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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f . OWNER's Address is 18 Buena Vista Ave .
Queensbury , NY 12801
2. CONTRACTOR or BUILDER'S Name
Sanitary Sewer Service
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3. CONTRACTOR or BUILDER'S Address P , O . Box 224 °D
Glens Falls , New York W
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d_ ARCHITECT'S Name C
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5. ARCHITECT'S Address :R
6. TYPE of Construction — (Please indicate by X)
I I Wood Frame I I Masonry I ) Steel I I
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7. PLANS and Specifications 6 hole dist . box and 2 6 ' x8 ' seeepage pits per plot and E
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No application
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8. Proposed Use rr
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Sewage system for dwelling
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10 . O17 May 14 is 89
$ PERMIT FEE PAID — THIS PERMIT EXPIRES
(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 14th Day of May 119 87
SIGNED BY / J/ad u for the Town of Queensbury
Building and Zoning Inspector
earn o ' Q6wy
-TOWN OF-
APPLICAMON FOR SEPTiC DISPOSAL FERMI D � r'
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MAY�14198 �Y V2 G,
MATE / BUILDING Ek C:ODF- DEPT*
LOCATION OF PROPERTY FOR INSTALLATION (� /
Owner's Name: *e } Q M 1 /�-f 1. ^j h / Telephone. � fc ` l!!
Address: _� Ir-► {�
Installer's Narnr e AJ f 1�/� �' fi` Telephone: � '/�
Number of bedrooms (residential only)
Total daily flow (compute (sP 150 gal per bedroom) r
Topography: circle one: Fla Rolling Steep Slope % of slope
SoH Nature: circle one: and Loam Clay Other / Depth: feet
('around Water: At what depth? feet
Bedrock or Impervious Material: At what depth? 1- feet
Percolation test: circle one: requirre required / rate min. inch.
Domestic water supply: circle one: :c a Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption _ feet
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PROPOSED SYSTEM : Septic Tank l (00L) gal. (minimum size: 1 ,000 gal.)
TILE FIELD: Each Trench '''� feet / 'Total systemr length feet
SEEPAGE PIT(S) : Number of T / Size each Lo feet by CT feet
Size of stone to be used # _ 3 / Depth or Thickness feet
IMPORTANT
_._Please.v.LIST NEW EQU PMENT TO BE INSTAI..I.ED
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
(over)
Section II Septic System Inspections:
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, the 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.
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.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system , a new proposal must be submitted
to the Queensbury Building Department before further construction,
I have read the regulations above and agree to abide by these and all requirements
Of the Town of Queensbury Sanit a Disposal
Signature of responsible person:
Date: e-
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY . A GOOD, PLACE TO LIVE
f7nWn Of Q"eenjiury
{ nd ZC NING DEPARTMEN
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J�''t11� gty� _O1NG a p . 1 'Box 98
''++�JII ,Bay and Hav;fand mew York 12W
C4ueensbury,
SEPTIC: DISPOSAL- SYSTEM INSPECTION
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UpGATION
PERMIT NO .��~
SCTL *TYPE - Sand - Lo�ea 'Ol S!No
percolation Test Req} Inch
Percolation rate Min/
TYPE of SYSTEM: total len<3th
Absorption field .
LengtY► of each trench
Depth Of trenches Size of g ---
ravel off �^
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SEEPP.GE PITS�cI31ft.
Size- 12�_fto }C
Gravel
S1ze Size TY "'
P XP J.NG : —_
Bldg . to tan �r t y t
-,i,t tobox to' fioeld/kes Partial
Dist- ",`I.��rE.-S''1 130
openings sealed
T,pGP,TI014/SE'PAIR'PATIONS :
�l ft�-
Founr3.ation GQ absorption ft -
round; tion to
Absorption to 10 is me ---f t.(circle one
Separation 0 p PRC]P'ERTYATI STEM Right side
Front Rear Left side
C:C HXFENT
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SYSTEM L3SE APPROVFSD
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Bu ilc3 ing
Inspector
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SANITARY SEWER SERVICE
Division of G. P. Drellos, Inc.
53 FOURTH STREET GLENS FALLS, N . Y. 12801
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TELEPHONE 792-7257
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