1987-642 BUILDING PERMIT �
TOWN OF QUEENSBURY �
Na. 87-642 �
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Gertrude Henry r�
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OWNER of property located at 11 Buena Vista Dr . 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,
1 . OWNER'S Address is
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11 Buena Vista Dr . rT
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Queensbury , N . Y . 12801 c
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2_ CONTRACTOR or BUILDER'S Name
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Condon ' s Septic
3. CONTRACTOR or BUILDER'S Address
17 Grant St .
Glens falls , N . Y .
4, ARCHITECT'S Name
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5. ARCHITECT'S Address
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B. TYPE of Construction — (Please indicate by X)
S Y Wood Frame I ) Masonry ( 1 Steal I Y
7. PLANS and Specifications r,
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No_ 1000 existing tank, each trench 40 ' , total sum 200 ' as per plot plan 0
and application) m
8. Proposed Use Sewage alteration
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$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES Sept 23 , 1989
(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,I
Dated at the Town of Queensbury this, yy� 23rd Day of Sept . 19 87
SIGNED BY � '" for the Town of Queensbury
Building and Zoning Inspector �[!
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APPUCATION FOR SEPTIC DISPOSAL PERMIT
Il DATE l !` -'L- 9-
LOCATION OF PROPERTY FOR INSTALLATION ,r
Owner's Name: i Telephone: 7 ��� fC►
Address: I" !� l �
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Installer's Name � y � Telephone: , -- '
Number of bedrooms (residential only) .._—
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Total daily flow {compute (,a 150 gal per bedroom.) �)
Topography: circle ones Flat Rolling Steep Slope % of slope
Soil Nature: circle one1 and Loam Clay Other / Depth: �r feet
Ground Water: At what depth? feet
I3edvock or Impervious Material: At what depth? _ feet
Percolation test: circle one: of require required / rate min, inch.
Domestic water supply: circle one:( Well Other
IF domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet
g'X ts& —
PROPOSED SYSTEM: Septic Tank 600 � gal. minimum size: 1 ,000 gal,)
TILE FIELD: Each Trench a�-/O feet / Total system length 2.00 feet
SEEPAGE PIT(S) : Number of J Size each feet by feet
Size of stone to be used # — / Depth or Thickness / feet
IMPORTANT
...Please...LIST NEW EQUIPMENT TO BE INSTALLED
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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 plat plan showing:
I .) 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, tile 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 Sanitary Sewage Disposal Ordinance.
Signature of responsible
^person*
Date: +
Town of Queensbury
Building and Code Department
Bay at Haviland Road
Queensbury, New York 12801
(518) 792-5832
SETTLED 1763 . . . KOME OF NATURAL. BEAUTY . . . A GOOD PLACE TO LIVE
."Jrruin 0eeeenJ6ury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
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NAME _ _ Iiu AIf?.' %1
LOCATION It f3cxZ A q�
DATE !- PERMIT NO .
SOIL TYPE - and - Loam - Clay
Percolation Tes Required? YES
Percolation rate - Min/Inch
TYPE of SYSTEM :
Absorption field , total length ZaS o
Length of each txench 5 0
Depth of trenches Z F
Size of gravel
SEEPAGE PITS{Number of
Size- £ f't . y
Grav s.ze _ �-
PrPING : Sz a Type
Bldg _ to tank
Tank to dirt . box
Disto box to field/pit
Openings sealed? YES NO Partial
LOCATION/SEPARATIONS :
Foundation to tank Al (e
Foundation to absorption 'z-0 ft v {-
Absorption to lot line (G ft:� e�f -?19
Separation of pits AdAtEtw
Df TION OF SYSTEM ON PROPERTY (circle one)
Front - Rear - Left side - Right side COMMENTS :
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SYSTEM USE APPROVED YE
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