2000-528 TOWN OF QUEENSDURY
742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201
Y.
Community* Development - Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20000528 Applieadon Number: A20000557
Tax 1\4ap No: 523400-060-000-0007-009-000-0000
Permission is hereby granted to: OLD COACH MANOR
Owner of property{located at: Apt. 33 Bay Rd
in the Town of Queensbury, to construct or place a Septic Alterations 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
Y 565 BAY Rd
QUEENSBURY, NY 12804
Contractor or Builder's Name / Address Electrical Inspection Agency
OUEENSBURY SEWER
JAY SWEET
Type of Construction: Septic Alteration Commercial Value : $
Plans & Specificati6ns
SEPTIC ALTERATION (SYSTEM 1 -APARTMENT 7 & 8 AS PER APPLICATION
535.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday, July 31, 2002
(Ifa lunge 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
S1GNEn BY for the Town of Queensbury.
Direr or of Building & e forcement
Application for Permit - Septic Disposal System
Town of Queensbury 742 Buy Road Queen,abury, ,NY 12804 ('518) 761-8256
1 . OWNER INFORMATION:
_...._..............................................................
_..........
.................
•....., _...
Location of installation: 0l7ice Use
Tax Map No. Gd '"' File Permit No.
Fee Paid �0--' Je
Owner's Name: .-' - � ..:.ten-. d .
I _._ .................._....-... %".........._.----------------------
r-c Address: _t= � „�.
� _ �.
/ a
2. INSTALLER'S NAME :. , PHONE NO. `:t'
3. RE C'E ORMATION: (circle year of dwelling, indicate 0 bedroom(s) and multiply 4 of
bedrooms with applicable gallons per bedroom to equal total daily}1ow)
f Bedrooms xACM&MRt9ion — TQfAl Daily Flow
1980 or older �_ , x 150 ga gl/bdrrn = 346
1980 — 199 € x 130 al/bdrm =
1991 — present x 110 gaVbdrm = JUL 2 8 2000
, , cry l ^y• - s Garbage Grinder Installed yes / no P ',r, .•
Spa or Whirlpool Installed yes 1 no
4. PARCEL INFORMATION: (circle applicable infornnation & indicate measurements)
it Nalmro GroundWater Bedrock r Impervigms Material Domestic Water Supply
Fla sand at what depth at what depth
0 Ing oa feet Lwe
Steep slope c cry ifwell; water supply
�RS slope other from any septic-system
depth: absorption is T}l.
other _
Percolation Test: (Tv be completed by licensed professional engineer or architect)
Rate: minute per inch
5. PROPOSED SYSTEM: For Nets 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 tarns and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: lr-,r-c 5 gallon (min. size 1, 000 gal j
Tile Field: each trench ft Total System Length: }t
Seepage Pit(s): number of size ofeach: }t. by }?.
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
Alternative System: V r—` length and/or size % ;;7 _j O t 1 _
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons / TOTAL Capacity: gallons
Nate: 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.
€g re responalble person Date
BUIL O TOW OF QUE�rsBURr
_ _ CODE ENFORCEMENT
742 Bay Road
Queensbury _ NY 22804
(518) 761-82 6
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date CD
Permit #
SOIL TYPE: alay-
Results of Perco? tiny
( if applicable) R to- est.
te/I ,nch
TYPE OF Min SYSTEM:
SORPTION FIELD:
Length of each trenOtal L ngth
Depth of trenches 4 lCy1
Size Of Stone
SEEPAGE PITS; Number
Size - ft . x
Stone size ft .
PIPING;
87dge to Tank Si a ype
Tank to Dist . Box
Dist . Box to Field/pit
Openings Sealed?
Feundation
LOCATIjo, EPARATI NO artaa
to Tank i
Foundation to Absorption 'feet
Separation of Pits feet
Conforms as per Plot plan 'feet
LOCATION OF SYSTEM ON a No
(circle one ) PROPER
F ° --= Rear - Left t
_7e_Fron Side - Right Side
. .�:. , :-----_���? e Rear
SYSTEM USE APPRDV
EIDO
Arrf YES NO
v y
Deb,
u di
I sP or ~�-