5170 BUILDING PERMIT
TOWN OF QUEENSBURY No. 5170
i 1''"� WARREN COUNTY, NEW YQRK
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PERMISSION is hereby granted to Thomas Moynihan
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OWNER of property located at Hillman Road ( C Pvem^e1a 1 e ) Street, Road or Ave_
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
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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t. OWIVER'S Address is Cleverdale , N . Y . 12820
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2. CONTRACTOR or BUI LDER"S Name
John Masons
3. CONTRACTOR or BUILDER'S Address
Cleverdale , N . Y .
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4. ARCHITECTS Name !,1
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5. ARCHITECT'S Address W
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6. TYPE of Construction — (Please indicate by XI 1N
( I Wood Frame ( Il Masonry f 1 Steel ( 1
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7_ PLANS and Specifications
No. New 250 gallon receiver .with pump per application and
diagram submitted .
S. Proposed Use
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Sewage system for dwelling
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$ 5 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES Sept • 1 ' 19 78
(If a longer period is required an application for an extension mush be made to the Building and Zoning inspector of the tf1l)'i
town of Queensbury before the expiration date.l y
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Dated at the Town of Queensbury this 5th Day of _ May 19 78 0
SIGNED BY for the Town of Queensbury
Building and Zoning I nsprector
TOWN OF QUEENSBUR.Y
WARREN CC7LJNTY. NEW `? �ItFC {��-,""t � � ,� '� `•'� IU-A LJ
Application for s� _
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A PERMIT TO CONSTRUCT , ALTER OR ENLARGE A :aEWPh� j1C�11jj2j112131415164
DISPOSAL SYSTEM+'. FOR A PRIVATE RESIDENCE WI T }-il t�, 4
TOWN OF QUEENSBURY
Mail or bring this application to %
Building & zoning Department
Queensbury Town Office Building
R. D . 1 Bay Road
Glens Falls , New York 12801
This application for a Sewage Disposal Permit must he
accompanied by a plot plan drawn reasonably to scale
showing all dimensions , the size of the lot , the location
on the lot of the water supply and sewage system .
' 1 . Name and mailing address of applicant :
C.c ✓,+'� p yo'I / Z Cr
2 . Specific location of property : ST EEi AN 'uJh.FsER
3 . Application is for :
New construction of private dwelling .
a[_ Alteration or enlargement of existing sewage isposal system .
4 . Description of building :
a . number of bedrooms
b , garbage grinder
YE:.� DR C1O
5 . Topography :
at , ro ing , steep s ope , gentle slope , etc .
6 . a . Nature of soil . ( Describe to a depth of 5 feet if the
field is to be used or 1C, feet if leaching Vits are
proposed , giving thickness of various strata such as
top soil , clay , loam , sand , gravel , rock , etc . )
b . How determined ? ' '�
7 , a . Soil percolation test made by
( Refer to Part III , Bulletin 19 N . Y . S . Department o Hea th
b . Percolation test notes submitted ? YES Di3 N£7
8 , Proposed sewac� e disposal system indicated on attached plan or
sketch? ) ; 5-
YES DR NO )
g' , Date when construction will commence _
to .'I if
It is hereby agreed that i f this ap } li : atrn` nta or rani C inn ed thr% reO l
dated J1. or any amend
are approve instaT�lation of sewage disposal facilities will e
made in accordance with the details thereof as shown on such
approved plans .
S ature o a .
pp cant
Installed By : Contractor - �sr 7dM 6ye*o .
owpe-r
"7 pRIAPPLICATICK FUR: A PEKtUT NIU (:7.1N&pL'Ltl L;I:', A'-% 'UN h 1C1[v�N OF
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A PRIVATE FESIDENC F, W1M_U r3 M TAKE GEORGE PARK.
1. I�iame and m&Uing address of owner pip ?� /H AW It/Iei pip
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,x ✓E ,qr� E N',E^OP Yf /rpp4tP
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2* specific location of property: ,f,F,rLG, 7Aa✓ ROAD
3 . Application is for : (check one)
New construction ?C. Alteration or enlargement of existing disposal system
4. Description of building : - Number of bedrooms �
5 . p . fie dimensions , or total area of property: CAle AGd�
6 . TC)POgrapby : doe^JT4#
at ro zng, steep M7pe , gentle slope , etc.
7 . Nature- of soil. (Describe to a depth of 5 feet below bottom of leaching dev:ice . )
Give sail . type , distance to gro adwater, disstance to bedrock.)
8 . a) A soil percolation test may be required. For details on procedure, refer to
"lndividval Household Systems _ Standards for Waste Treatment. Works" - N .Y .S .
Department of Health.
b) Percolation test result :
. .(Please attach test -notes .
90 Please attach a carefully drawn plan of the proposed sewage disposal system.
Give all dimensions , including distances to lot lines , wells (yours and
neighbors) , streams , -and Lake George . if. applicable .
10 . Ziie Twice George Park C amissi_on reserves the right to inspect the completed system
before backfilling. The owner is required to notify the C =&ssion. at least 24
Junws in advance of backfillixg, to facilitate the final approval irnsPection..
1110p , C',cros truction will begin on �) d` by JO ffn/ Afl*-SOAI
trac for
I hereby agree that if this application and attached plans dated /-
or any amendment or revision thereof, are -approved, installation o sewage �a�L
facilities wi11 be. wade. in accordance with the details thereof as shown on such
approved plans , wlth:Ln 180 days of the above date . One extension of 180 days will
be allowed if applied for and. secured in writing. --- 4!!1r 117
A'n� Tdwa ��oowner) _ . Date)
The lake George Park CoraLssion has reviewed the plans and site location for this
project and accordingly recommends approval.
By ' ZiEnDate.
I ,
Asst . Hydraulic Engine= pri
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date
Name f
Location
Permit No. `�� 11 Weather
V Per Cent Rear�rlrs
Complete
Excavation
Footing Forms
Footing & Piers
Foundation
Cement Coat
waterproofing
Backfill
Final Survey
Framing
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plh .
Rough Ht .
Relief Valves
Wall Board
Ext_ Porches
Finished Floor
Interior Trim
Stairs & Railings
Cellar Dr. Tile
Concrete Floors
Pib . Fixtures
Gar. Fireproofing
Boor Closers
Chimney
Water Meter lttet.
Septic Approval tI IV Yj
f� fit
$oild'asng lxtirpecxar
REMARKS
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. AIR VENT
Eti. EC-T ,OICAL RECEPTACLE
400
k
I" PVC pi PE k I
I
AcolkE
R TRAIN
FROM LREPTIC VAImVie
TANK — ---i►—
C
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CHECK r " FMG ' PIPE
ALARIA SWITCH
� e.W low
I
ON SWI i rK t r�R
T � �fVi4
OFF SWITCH P"p
PUMP SWITCH
2" pvc HEAD A — S� aPSD
Yoe, " Ft• BACK Ta If4LEr
P3 r , 8Y GA Gr'a A T
ALL PIPG SXY J.&V,EL
END CAP H17LES ON SOTTs?M OF J " PVC PIPE p "' PYC
1pnaM PL04p
HOLES SPACIED
/ 3OM — 30
• 7 lryi YE.',.. •.r'+i.Jf�t1.. � .�. 4.�.'; l.�il i li 1�.Hi r:, j..Ni\ : �.71j V. r.:u i. i r .,E it L41 t'r': i �� y � �
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The above sketch shows the locations of the units comprising your sewage disposal
system for future reference in case of difficulty. It shows measured distances
from buildings , trees , garage , fence posts , etc . , to septic tank , sewers , distri -
bution box and absorption field or seepage pits .
CONTRACTOR: )C? � � '� � � � - DATE INSTALLED :
D E S I G N B A S I S
1 . No. of bedrooms : "7 5 . Septic tank * type Ccr�, c ,-t c�
2 . Daily flow : gpd capacity /00 0 gals .
3w undisturbed soil depths : 6 . Size of leaching device : / 20 ft .
a . To groundwater: ;!7 7. Type of system ( conventional , fill ,
b . To impervious lens :
etc . ) : rf7,.-ir s5 u. c----
4 . Percolation rate : min/in .
LGPC MAP NO . : APPROVED BY: DATE :