1989-367 c
BUILDING PERMIT
TOWN OF QMUEENSBURY
No.
WARREN COUNTY, NEW YORK ;
ex
PE R M I SSI ON is hereby granted to ►+
OWNER of property located at 17 Buena vista �"+ �► Street, Road or Ave.
in the Town of Queensbury. To Construct or place a
at the above location in accordance to application together with pot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1 . OWNE R'S Address is
W
S am
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G
T
Y
2. CONTRACTOR or BUI LI]E R'S Name C ,
Condons Septic
3. CONTRACTOR or BUILDER'S Address.
Glens Falls , H . Y . 12801
d. ARCHITECT'S Name
5. ARCHITECT'S Address
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r;.
C!`
B. TV PE of Construction — IPlease indicate by X)
l y wood Frame i ) Masonry l l Steel I l
7. PLANS and Specifications
No. aA 300 gal grease trap for grey water only, 1 +6 ' x 8 ' RIK seepage pit
as per plot plan and application _ m
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8. Proposed Use
Sewage Alteration
r•r
M
9
$ 2 OO PERMIT FEE PAID — THIS PERMIT EXPIRES IAa�7�i lame—9� ^'yam'
Ilf a lo nger 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 Day of May1J$4—
SIGNED BY for the Town of Queensbury
Building and Zoni nd Inspector
TOWN OF QUEE SBVRY � moo- � � �
APPLICATION FOR 'row/ QU Ns
Ecsr
41 SEPTIC DISPOSAL PERMIT �
AfAY 2 6 I98.9
DATE `
LOCATION OF PROPERTY FOR INSTALLATION G ,r'
Owner's Name:7) n #jry L ,uloy.4 Telephone: , o' 13o J
Address: f �7 �,�[I foW A N� 5 AA
Installer's Name: C ► L< 2/0 �`��,Q � rc Telephone;
Number of bedrooms (residential only)
Total daily flow (compute (d 150 gal per bedroom)
Topography: Circle one: lat Rolling Steep Slope % of Slope
Soil Natures Circle one./San one./SanqY Loam Clay Other /Depth*Feet
Ground Water: At what depth? Feet
Bedrock or Impervious Material: At what depth? /fJ -[Feet
Percolation test: Circle one: not required required rate /f//,£� min. inch.
Domestic water supply: circle one: Municipal Well Other
If domestic water supply is a well:
Separation: Water supply from septic absorption meet
PROPOSED SYSTEM: Septic Tank gal. (minimum size: 1 .00n gal.)
TILE FIELD : Each Trench feet/Total system length feet
SEEPAGE PIT(S): Number qqof Size each� feet by 5f feet
Size of stone to be used # J /Depth or Thickness� feet
I have read the regulation on the reverse side of this sheet and agree to abide by these
and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance,
SIGNATURE OF RE//S'' PONSIBLE PERSON: �- 7r
DATE:
OVER
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 sturt
of construction and shill 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 ,
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 installa—
tion , alteration or repair of an approved system , a new proposal must
be submitted to the Queensbury Building Department before further
construction .
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury , New York 12804
Remarks :
awn 01 Queerxshurry
BUILDING and ZONING DEPARTMENT
F;p
Bay and Haviland Road, R. D. 1 Box 96
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME-.
LOCAT
DATEe5; 142:Z PERMIT NO .
SOIL TYPE - <zian Loam - clay -
percolation Test Required? YES - NO
Percolation rate - Min/Inch _
TYPE of SYSTEM:
Absorption field , total length
Length of earl trench
Depth of trenc es
size of gravel '
SEEPAGE PITS4N er of)
Size- ft. X ft.
Gravel size , 3 —
PSPING : IZ Type �
Bldg . to tank ¢
Tank to dirt. box r f�a
Dist . box to field/pi
openings sealed: YES\, No Partial
LOCPsTION/SEPARA ONS =
Foundation to t nk. ra ft.
Foundation to Absorption
Absorption to, lot line &Q�ft .
Separation 4:& pits ft-
LOCATION OF YSTEM CN.3 PRopE� (circle one)
Front -lea, - Left side - Right side -
COMMENTSs
SYSTEM USE APPROVED YES No
Build ng Inspect r
01,/86 and vl
troy 3 �1vUr `�� 13 �`,� �,v c W s ..� � �c � �4h�litl s@ ce
t? u Fpm U'i aj. OAAA)� AUK. # pk gs?
� J
70
35
3 ok
TOWN OF QU BURY
BUILDING JEDEPT,
REVIEWED BY
DATE