2000-527 1,
TOWN OF +QUEENSBUR.Y
(aw 742 Bay Road, Queensbury, NY 12804-5902 (518) 761 -8201
Community Development - Building St Codes (518) 761-8256
BUILDING PERMIT
Permit Num r: P2001DO527 Application Number: A20000556
Tax Map No: d 523400-060-000-00W- 09-000-0000
Permission is hereby granted to: OLD COACH MANOR
Owner of property located at: Apt�3. 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. LAMBI INVESTMENTS
565 BAY Rd
QUEENSBUR'Y, NY 12804
Contractor or Builder's Name / Address Electrical Inspection Agency
QUEENSBURY SEWER
JAY SWEET
Type of Construction: Septic Alteration Commercial Value : $
Plans & Specifications
SEPTIC ALTERATION (SYSTEM 2-APARTMENT 9 & 10 AS PER APPLICATION
$35.00 PERMIT FEE PAID - THIS PERMIT EXPIRES, Wednesday, July 31, 2002
(Ifa longer period is required, an application for an extension must be :Wade to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury; Monday, July 31, 2000
SIGNEED BY for the Town of Queensbury.
Dir r o uil ' g 4kforcement
Application for Permit -- Septic Disposal System
Town of QueenSbttry 742 Bay Road Queensbury, NY 12804 (518) 761-8256
L OWNER INFORMATION':
_........................................ ..... ................................ _...........................�
Office Use
Location of installation:
Tax Map No. ^
File Permit No,
� � r _�„�.. r i
Owner's Name:
Fee Paid
c�.c�.� ,.-^��..�� y�-��_
Address: �G- .��. ,�" (, -�/ .— -r� �.z�� y �C� `l C
2. INSTALLER'S NAME r r` PHONE NO. ZFz G�
3. RE ENCE INF ATION: (circle year of dwelling, indicate 4 bedroom(() and multiply # of
bedrooms with applicable gallons per bedroom to equal total daily.,l7ow)
r of B s x a uta ion = T l Dai1 Flow
980-�r oiler ,.� _ x 150 galrbdrm =
1980 =' x 130 galrbdrrn =
1991 — present x 110 galrbdrm =
Garbage Grinder Installed yes _ r no
Spa or Whirlpool Installed yes _ 1 no
4. PARCEL INFORMATION: (circle applicable information & indicate measurements)
Tonouraphy Soil Nature Ground Water Bedrock or Impervious Ma erial Domestic Water Supply
our . sand at what depth at what depth enr
g feet ,., Vw feet
Steep slope if well; water supply
slope other from any septic-system
depth. absorption is ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. PROPOSED SYSTEM: For New {Construction: All individual sewage disposal systems roust 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 tank and leach Held for each Garbage Grinder, Spa or Whirlpool Tub,
Septic Tank: kC`.�tj gallon (min. size 1, 000 gal.)
Tile Field: each trench ft. Total System Length: ft.
Seepage Pit(s): number of size of each: fl, by ft.
Size of Stone to be used: li / depth or thickness _feet
t
Bed System Size: �' x
t
Alternative System: ��i ,� length and'or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks; r Sine 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 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 the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Sl n re of responsaksle person Date
4 o0%
TOWN OF QUEENSBURY
BUILDING_ _&_.CODE 'ENFORCEMENT
742 Bay Road
Queens bury NY 12864
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTIONY
Name DL,U CQEK i
Location N VT4G {
Date--' Permit #
SOIL TYPE: any a
Results of Percolati Test-
( if applicable } Rate inute/ T h
TYPE OF SYSTEM:
ABSORPTION FIELD : To a"f L"ength
Length of each trenc
Depth of trenches
Size of stone
SEEPAGE PITS : Humber
Size - ft . x ft .
Stone size
PIPING: Saze e
Bldg . to Tank
Tank to Dist . Box rr
Dist . Sox to Field/Pit
Openings Sealed ? es o artia
LOrATI OK/SEPA1tATI
Foundation to Tank eet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot Plan e
LOCATION OF SYSTEM ON PROPE
( e one )
ro r - Left Side - Right Side
fiddle Front Middle Rear
COMMENTS ;
SYSTEM USE APPROVED : �"Y� S No
Arriv
Deg s
a
Wilding n tar