2000-166 b � b
'ertifxate of uompimnee
'town of Queensbury , `
Warren County,New York
Apr l 18F 2000
Date
2000166
This is to certify,t at work requested to be done as shoe qi by Permit No.
has been completed,
SEPTIC ALTERATION
This stmdure may be used as a µ_
26 BUENA VISTA AVE,
Location
'owner MILLER, THOMA
TAX HAP NO. 7 9 a ~ -I0 0 2
By Order Town Board
T OF QUEENS ,URY
_ .lf
Director of Buildi g & ode"Enforcement
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518)761-8256
VALUE $ 0 Building Permit No. 2000166
TAX MAP' NO. 79 . -3-10. 2
Permission is hereby granted to MILLER, THOMAS
Owner of property located at 26 BUENA VISTA AVE.
in the Town of Queensbury,to construct or place a SEPTIC 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 NYS Uniform.Building Codes and the Queensbury Zoning Ordinance.
Owner's Address:
26 BUENA VISTA AVE.
QUEENSBURY, NY 12804 _
Contractor or Builder's Name:
I .B. S . SEPTIC
Contractor or Builder's Address:
2 LOWER WARREN STREET
QUEENSBURY, NY 12804
Electrical Inspection Agency:
Type of Construction:
SEPTIC
Plans and Specifications:
SEPTIC ALTERATION AS PER. PLOT. PLAN SPECIFICATIONS
Proposed Use:
SEPTIC ALTERATION
25 April 6 2002, . -
$ PERMIT FEE PAID—'.PHIS PERMIT EXPIRES
(If a longer period is required,an application for an extension must be made to the Code Enforcement
Officer of the Town.of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 6 Day of April 2000
SIGNED BY for the Town of Queensbury
Code triforcement Officer
Application for Permit—Septic Disposal Sy'stem
Town of Queensbmy 742 i3ay Road QMee.11sbuiy. NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation: R ffi
ev-e 't-1 C__ L"
Tax Map Na. —1, Filo'Porn.
Owner's Nm ae 6 Fee Paid Oa
(c
.................... ..................................................................
Address:
2. INSTALLER'S-NAME
_5F1 G f PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(v)and multiply 11 of
bedrooms with applicable gallons per bedroom to equal total dailyjlow)
Year of House: -No-'of Bedrooms x Computation = Total Daily Flo
1980 or older X 150 g.al/bdrin 1980- 1991 x 130 gal/bdrin
J 991 —present x 110gal/bdriii
Garbage Grinder Installed yes no X-
-Spa or Whirlpool Installed yes no ZQQQ
4. PARCEL INFORMATION: (c cl�
ircle applicable information &indicate measurements) �j�:"=V'JISWRY
-rov'I'M cfi-
B%JILEANG 609
VPZra h To So' ture Ground Water Bedrock or lu pervious Material 713011icstic:water Supply
' 13 Y
qa
at&wl"2 d p1h at whaWelw h Iu
�ic l ?a
offing in eel feet we
Steep.slope clay if Well; W_Ie r supply
.%slope other if well;
any septic-system
depth:
absorption is
other
Percolation To : (To be completed by licensed professional engineer or architect)
Date: , I L nfinute per inch
5. PROPOSED SYSTEM: For New Construction: All individtial sewage disposal systems must be designed by a licensed
professional engincer or architect(ui*dcss installed in a Planning Board approved subdivision). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool'rub.
Septic Tank: gallon(min. size 1,000 gal.) c
Tile Field: each trench fT Total Syst6m'Lefigth:
Seepage Pit(s): number of size ofeach: ft. by__jf5ft
Size of Stone to be used li depth or thickness j je'j
Bed System Size: X
Alternative System: length and/or size
6. HOLDING TANK SYSTEM. (if required)
Number of tanks: , Size of each: gallons /TOTAL Capacity: gAllons
Note. Alarm System and associated'electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
For your protection,please note that pursuant to Section 13 6-29,of the Code of the Town
of Queensbury, any permit or approval granted which is based upon.or.mgranted in
reliance upon any material misrepresentation or failure to make a material-fact or
circumstance known by or on behalf of an applicant=shall be void.
I have read the regulations with respect to this application and agree to abide by these and all
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
FYI: JT _71/
signature of responsible person Date
-TOWN OF QUEENSRURY
FEU XUDING CODE ENFORCEMENT
Ruact
-- Ray
NY XZB64
SEPTIC DISPOSAL. SYSTEM INSPEC-rION
Name
Loca-titin
D a-t e- p c--T-M-1 -t
SOIL TYP Sa. d- cram- CT ay-
Resul is . o-F vcola-tion 'Tes-t-
( i -F applicable ) Ra-tt---M4pu-te/ lnch
TYPE OF SYS-YEN= -111,�10
ABSORP-rlOff FIELD - TotalLength
Length of each '-tr- nch
Depth of trenches
Size cif stone
SEEPAGE PITtS - N u E? T--f,._t(nb
S 1 Z e- W. x -F-t
Stone size
PIPING: Le T DOM
Blcfg . -to Tank'
Tank to Dis-t B o
Dist; - Box -to Fiel VA
Openings S-e-aled? P-a v--t 3 al-
I-0 C A I F I 10 N Z S E P A RA-F
Founa-t! on
o to
Tan -F '-t--7t d -t
Foundan o -Ab%S
s r-p -ti on -F 4 e' ,e-7t-
Sfapay-a-tlan c)-V- -- Pi -t!w -F e e--t
Con-Forms as per PI -t P1 an es No
t- --Tl0N OF4 -'SYS-YEMI�OH PROPER-T •
F -con Rear - Le-Ft Side - Righ t Side
_Icle Front - Middle -Rear
COMMEN-FS
SYS-FEM USE APPROVED= YES NO
A v-r--f v ted
Do--p at r-l--qa-qd op ps
Bullaino I"sp c2!4---tup T-
3 �� or✓a�} ��� �� ,a OJV
01
, 4
gx
(VI
OP,
DP, -
TC10 yf
^_
000 dd I f
"I have seen or observed, or believe I saw evidence of,
all objects such as houses; weds, trees, fences, etc..
shown on this document. I also represent that I have
Personally sLred the istances set forth on the diagram."
- SIGNATURE DATE
lid-� �OJO - s =
-FObM
BUILDING & CODE ENFORCEKENY
742 Baa_y Rcba4
MY XZB04
(518) 761-8:256 -
SEPTIC DISPOSAL SYSTEM INSPECTION
Name Vim-
L o c a-t 1 a n
D a t--e P 0 W-m i -t # cs-b
SOIL T-YPE: San L"am- Cl a-y-
Resul is of Percolation Tes-t-
( 1 -F applicable ) Rate-Minute/Inch
TYPE OF SYSTEM=
ABSORPTION FIELD: Total LengthC'n
Length of each 7t r-e?frc-v- h
Depth of trenches
Size of s-tone,
SEEPAGE PX-FS : Num ber--
Size F-t x j f 7t
Stone size \ 7--
PIPING : Size Type
BI dg - to Tank
Ta to Dist - B oxf
s-t - Box to Fielt a-4--tl
I
penings Sealed . es No P a Y-7ti al
ILOCA-TIONZSEPARA-F OHS :
i -to l--
Founda ,ton -Foe
Found a-tion -to Ablor-p -tion feet
Sopai-a -tion of-* pi;�--s -F e a-t
Conforms as per- J'Plo-t Plan Yes No
L-OCA-FION OF SYSTEM ON PROPERTY:
( cir-cle one )
Front - Rear Left Side - Right Side
Middle F7r-on , - Middle Reav-
COMMEN-TS
SYSTEM USE APPROVED = YES'-S No
---
Departed