2003-326 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804.5902 (518)761-8201
Community Development-Building&Codes (518)761.8256
U`rtRT1FIr..1',rE V"Ir 'C'OMPLIANut
PennitNumber. P20030326 Date Issued: 'Wednesday, October 20,2004
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This is to certify that work requested to be done as shown by Permit Number P20030326
Tax Map Number. 523400-301-017.0001-055-000-0000
Location: 24 JOHN St
Owner.. RICHARD&BARBARA.LAPOLLA TRUSTEES
Applicant: RICHARD&BARBARA LAPOLLA TRUSTEES
This structure may be occupied as a:
ByOrderof Town Board
Septic Alteration Residential TOWN of QUEENSBURY
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Director of Building&Code Enforcement
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TOWN OF QT.JEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (51$)761-8201
Community Developtrient-Buiiding&Codes (518) 761-8256
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BUILDING PERMIT
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Permit Number: P20030316 Application Number: A20030326
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Tax Map No: 523400-301-017-0001-055=000-0000
Permission is hereby granted to: RTCHARD&BARBARA LAPOLLA TRUSTFFS
For property located at: 24 .JOHN St
in the Town of Queensbury,to construct or place k"
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: RICHARD&BARBAI2A.LAPOLLA
24 JOHN St Septic Alteration Residential
QUEENSBURY,NY '12804-0000 Total Value
Contractor or Builder's Name'/Address Electrical Inspection Agency
OT JF,F,NSBT TRY SEWER
JAY SWEET
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Plans&Specifications
2003-326
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES:. Friday,May 28,2004
(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 of Q nsbury; Wednesday,May 28,2003
SIGNED BY —for the Town of Queensbury.
Director of Boil ' g& de 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: "9
File Permit NO.
Tax Map No.
Fee Paid
Owner's Name: tom,,_
..........
Address: T-- 71 ......
2. INSTALLER'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/bclnn
1991-present x 110 gal/bdrm = RECEDVED
Garbage Grinder Installed yes— 4!�>—
Spa or Hot Tub Installed yes_ L29D-- MAY 2003
T0\(VN OF QUEENSBURY
4. PARCEL INFORMATION: (circle applicable information&indicate measuremenMILDING AND_CODE
Too Lyrauhv Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
.-�at-, (:�s at what depth at what depth 2�x �
�oling loam feet feet well
Steep slope clay 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 must be designed by a licensed
professional engineer or architect(unless installed in a Planning Board approved subdivision). Add250 gallons to the size
of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub.
Septic Tank: gallon(min. size 1,000 gal.)
Tile Field: each trench 0 ft. Total System Length: oZ6'tP 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: x
Alternative System: -x 4--y-c length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons I 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.
S 64urA,of resjdonsible person— Date
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,`>mVe s Ilrltl Sew;ige Disi)t s—al Cllslt)tt•r
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Septic Inspection Report
Office No.(518)761-8256 Date Inspection reques eiv
Queensbury Building&Code Enforcement 'Arrive: a p M
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initial L C
NAME: P IT NO.:
LOCATION: PELT ON:
RECIIECK:
Comments and/or diagram
Soil Type:(San Loam 1 Clay
T e ofWater: FunicipaI2 Well Water
Waterline separagon,distance
Well separation distance
Other wells: fftt+ AC
Absorption Field: Total length
ft.
Length of each trench V�q
Depth of trenches ft.
Size of Stone
-Seepage Pits: Number
Size: X
Stone Size:
Piping Size Type
Building to tank
Tank to DWAbad—G
Distribution Box ield t Pit
Opening SealK: J aitial
Location/S6parations,
Foundation to tank ft.
Foundation to absorption
. .,Separation of Pits ft,
Conforms as per Plot Plan N
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
System Use Status:
A
P al Approved and needs to be re-inspected,please call the'Building&Codes Office
sapprov
Status:
L:\SueHemingway\Building.Codes.Inspection.FORMS\Septi-,Inspection Report.doc January 28,2003
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Septic Inspection Report
Office No. (518)761-8256 Date Inspection re nest ved:
q e rste d,
v a e a a Queensbury Building&Code Enforcement Arrive:
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initia s.
NAME: NO.:
LOCATION: INSPECT ON: Z I?)—c3
RECHECK:
Comments and/or diagram
Soil Typ r- San4Z 4.
.2,a�!;lay
Type of �. unicipajpWell Water
Waterline separ stance
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length -7-.0
Length of each trench
Depth of trenches -L, ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank \4p,t ,0
Tank to Distribution Box
Distribution Box to Fi eW/Pit
Opening Sealed: Y( al
Location/Separations
Foundation to tank ft.
Foundation to absorption lr` ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
System Use Status:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
- ------^^ �
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"OWN. Gr QUE Z�;, ��
BUILDING D
REVIEWED
DATE
RECEIVED
µ _ _ MAY 2003
WN OF QUEENSBURY
BUILDING AND g
a`
b
' II
w 10 1 have seen oi observed,or believe I saw evidence of,
all objects sucl as houses,wells,trees,fences,etc.,
�
shown on this ocumeht.I also're resent that I have p
personally measured the distances set forth on the diagram."
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1 NATURE DAH