2000-526 TOWN OF {QUEENSBURY
742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number. P2D(?DD526 �{ Application Number: A20000555
Tax Map No: 523400-060-000-0007-009-000-0000�
Permission is hereby granted t OLD COACH MANOR
Owner a property located at; �pt. 33 Bay Rd
in the Town of Queensbury, to construct or place a Septic Alteration Commercial
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.
Owner Address: INC. LAM.BI INVESTMENTS
565 BAY Rd
QUEENSBUR.Y, NY 12804
'e
Contractor or Builder's Name / address Electrical Inspection Agency
OUEENSBURY SEWER
JAY SWEET
Y.
Type of Construction: Septic Alteration Commercial Value : $
Plans & Specifications
SEPTIC ALTERATION (SYSTEM 3-APARTMENT 11 & 12) AS PER APPLICATION
S35.00 PERMIT FEE PAID - THIS PERMIT EXPIRES; Wednesday, July 31 , 2002
(Ifa 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; Monday, July 31, 2000
SIGNED 13Y for the Town. of Queensbury.
Dire t orcement
Application for Permit — Septic Disposal System
Town of Queensbury 742 BOY ROOd Queensbury, IVY 12804 (518) 761-8256
1 . OWNER INFORMATION:
.............. ...... ................._..............,,,,,,,................................_..........W..................,
Location of installation: OfTicr Use
1
Tax Map No. Fite Permit No
Owner's Name: Fee Paid
_... .. .. _ ... __................. . ........... ..........................
Address:
p P a"e+ "I-V4 � v�
2. INSTALLER'S NAME : Y. PHONE NO. 7'9vz- -sgyr�
3, ENCE ORMATION: (circle year of dwelling, indicate # bedroom(s) and multiply # of
}J bedrooms with applicable gallons per bedroom to equal total dailyf7ow)
Y f us No. ofBedroa s x o utatian = Total Dail Plow
"x r ,
U98 0 lder x 15U gallbdrm = m JUL 2 8 2000
1980 - 1991 _ x 130 gaVbdrm
1991 - present x 110 gal/bdrm
Garbage Grinder Installed yes . / no Spa or Whirlpool Installed yes J no (00 - j
4. PARCEL INFORMATION: (circle applicable information & indicate measurements) J
7Roing
it r r n W Bedrock or I ervi us Material Dom io Wat r Supply
sand at what depth at what depth munictpat.
1oa feet ,� feet welllope c ay if well; water supply
slope other from any septic-system
depth: absorption is J1.
other
Percolation Test: (716 be completed by licensed professional engineer or architect)
Rate: minute per inch
5 . PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed
professional engineer or architect (unless installed in a Planning Board approved subdivision). Add 250 gallons to the size
of the septic lank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: { ga" 17on (min. size 1, 000 gal.)
Tile Field: each trench �f?. Total System Length: f
Seepage Pit(s): number of size of each: ft, by ft.
Size of Stone to be used: # / depth or thickness feet
Bed System Size:
Alternative System: '� h� length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: J Size of each: gallons J 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 136-29 of the Code of the Town
of Queensbury, any permit or approval granted which is based upon or is granted 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 thgT.Qwn of Queensbury Sanitary Sewage Disposal Ordinance.
Sign r responsible person pate
TOWN OF QUEENSBURY
BUILDING s CODE ENFORCEMENT
742 Bay Road
Queen_ sbury NY 18C14
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date Permit
SOIL TYPE< I ay-
Resul is of Percolation Test-
( if applicable ) Rate-minute/ Inch
TYPE OF SYSTEM•
ABSORPTION FIE * ot�Length
Length of each tren h .=3 •�-= '�
Depth of trenc s � � _
Size of stone 4�
SEEPAGE PITS : umber-,�
Size - x ft .
Stone size
PIPING: Size �Yp�
Bldg . to Tank
Tank to Dist . Box +'
Dist . Box to Field
Openings Sealed'? Y No Partial
LOCATION/SEPARATION
Foundation to Tank feet
Foundation to Absorpti feet
Separation of Pits eet
Conforms as per Plot P
LOCATION OF SYSTEM ON R P
( circle one )
Fre�pe� Left ide - Right Side
dd_ 7�_��coMid a Rear ' ,
SYSTEM USE APPROVE _ YES
Arri ►r
Depa
L.*7� uWding FifigAcpor