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TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
- Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: BOTH-000439-2016
Tax Map No: 309.9-1-46
Permission is hereby granted to: Sanitary Sewer Service
For property located at: 57 INDIANAAVE
In the Town of Queensbury,to construct or place at the above location in accordance with 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
Tyne of Construction
Owner Name: MARK POLVERELLI Septic Disposal $0.00
Owner Address: 57 Indiana AVE Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Sanitary Sewer Service
PO Box 224
Glens Falls,NY 12801
Plans&Specifications
Residential Septic Alteration
$ 40.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Monday, July 3,2017
(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 f Quee ury; Fria , J 016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL APPLICATION Office Use Only
Received
DATE: Tax Map ID
TAx MAP ID: Permit No. em Vk-k ' y Zo 110
Permit Fee 1,4tD t nvg j,U�
ZONE:
APPLICANT VA r/C f O �� �. l j� PHONE/E-MAIL C -r —3 C-
ADDRESS S^ ] -7 11 � ,��, v¢
INSTALLER/ fI PHONE`/E-MAIL
BUILDER A-C 41
je4l--(2
OWNER
ADDRESS
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: X01^ 7 F=s
PHONE/E-MAIL
RESIDENCE INFORMATION
Year Built #of bedrooms X gallons per bedroom =total Daily flow
1980 or older tij f/0 Garbage grinder installed YesNo
1981-1991 Spa or-Hot Tub ins lied Yes No
1992-Present
PARCEL INFORMATION
Topography Plat rolling Steep slope %Slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth: A-4
Bedrock/Impervious material At what depth: N j
Domestic Water Supply Municipal Well(if well,water supply from any septic system absorption is_ft.)
Percolation Test Rate: /` 5 per minute per inch(test to be completed by licensed engineer/architect)
?PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank size 1/jeEL gallons(min.size 1,000 gallons,add 250 gallons to size for each garbage cylinder or spa or hot tub
System Absorption field with#2 stone Total length ft.;Each Trench
Seepage Pit with#3 stone How many: ;Size
Alternative System Bed or other type: x Zc f
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will
no longer allow systems to be covered until such time as an As-Built plan is received&approved. The installed system must match the
septic system layout on file—no exceptions.
Declaration: Any permit or approval granted which is based upon or is granted in reliance upon any material representation 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 and agree to
abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
PRINT NAME: l CC' cif DATE.
SIGNATURE: 26 DATE:
Town of Queensbury Building&Codes Principal Structure Application Revised September 2014
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TOWN OF QU
m BUILDING &
Reviewed By:
Date:
I
I
Morn: Thomas Center Jr tceilter3S Ccoyahoo,coin
Subject: Pulverellie Letter
Date: July 7,2416 at 9.45 AM
7o: George Drellos gdrellos@gmail.com
See attached.
Tam Center Nace Engineering, PC.
PROJECTCENTER
SERVICES
5 Shendan 5trcei.Glcni-Falls-NY 1:2titil
Jill,.,'. "F)](+
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l ro.iccz rL'234
t corvc Drellos
Sanitary Szwer:tier=cc
Queettshur•,r.NY 12,604
Re: Proposed Replaccnicnl Septic
57 Indiana:1i e,Queensbury.NY
Dear Geor re:
A. vi)ur request we ha3'c Tvviewed vilur prorkvcd replaccinenl septic iystcm desivn of the
ems,iinr 7 edroon: hou c al 57 Indiana Avenue- in lluccivsb rrv- :is ner our convcnvalion Ehc
residence hai in existikp railed';Cp . St'�i2I1L
We havC TOVI ;'ed lht propo_<ed relrlaeeiFitiE septic!.r icm de-iii-ii and iva'grce thal 8 Standard
-bsorption hed is aeLeptable.Based up':)n a dcsiur,f%iw rate of 3'l:,(3i'17 and a percolation rate of
in 5 minute:,vOu will[teed a nimimun:. -245_�Ltl'3tli�t{?L7iTn arca. We rccornme id iisik!21'
1 wpide by 21) tl longi; alisomliorr bed xviih 4 - 15 31 hong. lateral;. The absorption ;ymcn. can he
::or`Irucled with ilic~etisiin+g 1,090 gallon.ique tank.new Jislnl cion box-and 4 inch dian Mr
perforated pipe and mconi%
Pleasc ecl :Fie to contact tie aL 71)6-2515 if you have tiny i ucstiops and heat you for ?OUT
astilSliinec with rh15 rcquest.
Nincerely.
Thomas Center Ji
Thotitas K.Center Jr.P.E.
JUL 0 7 2016