2000-881 AAdimiW
TOWN OF QUEENSBURY
• 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
PON
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20000881 Application Number: A20000881
Tax Map No: 523400-009-000-0001-031-002-0000
Permission is hereby granted to: DAVID GORDON
For property located at: 36 BAY Pky
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. Type of Construction Value
Owner Address: WILLIAM & JOAN SCHWAB Septic Alteration Residential
36 BAY Pky Total Value
LAKE GEORGE,NY 12845
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans & Specifications
2000-881-DAVID GORDON
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Saturday,November 16,2002
(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 To of eens r Ti s y y,November 16, 2000
SIGNED BY for the Town of Queensbury.
Director of Building& Code Enforcement
Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation: 3(,o B4 ' PAt2K.Wd�
Tax Map No. i / / S i 1Z File Permit No.
Owner's Name: PAA/1 O G 02001,1 Fee Paid a-5
Address: Se,,0 PAtzy..,wAT '''7c --l{ 9 .- I-3
I.
2. INSTALLE1.'S NAME : PHONE NO
.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s)and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older x 150 gal/bdrm =
1980- 1991 -- x 130 gal/bdrm =
•9 present 2 x 110 gal/bdrm = 2.2-O
Garbage Grinder Installed yes` / no X
Spa or Whirlpool Installed yes— / no x
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
Flat sand at what depth at what depth municipal
Rolling loam OI feet — feet well
Steep slope clay if well; water supply
l5 %slope other from any septic-system
depth: 5 absorption is ft.
other Lbtc.�
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: 30. p 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 tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: 1000 gallon(min. size 1,000 gal.)
Tile Field: each trench 14 ft Total System Length: 5 2 ft
Seepage Pit(s): number of — size of each: — ft. by — ft.
Size of Stone to be used: # / depth or thickness — feet
Bed System Size: 3 x 2G f'r
Alternative System: EL,.5E1- length and/or size S5E., Pt-01 PLA r' A T1A GHSp
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size 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 e Town of Queensbury Sanitary Sewage Disposal Ordinance.
, 7/4. /11/ 27k,
ignature of responsible person Date
Main Office 176 Doe Run Road-Manheim,PA 17545 ,
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVi ;L
`- P 71 C i-14,a,v- eaiu 7 LS ' -P
Panel Board No Cert. NO 69471 Cut-in Card No. ./ k? /
Owner // aQ eDd `.e.>
Location /3 i t /&kwI (J2e y
Installation Consisting of 3 3 t /3 3,=-e--e��P t . -& _/ 72-)-S,j
a...1 -A.�. F�5.:..., a fr - '-/sr c�
Installed By G1"f,J2�6 �� Lic.No.
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of ma�,,���' inspections at any time, and if its
rules areviolated,the "
Company shall have the righ'to yoke �� t
Date ��✓ INSPECTORS
Member N.F.P.A.,1.A E.I.
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