2015-328 TOWN OF QUEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
Q rY
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150328 Date Issued: Tuesday, August 11, 2015
This is to certify that work requested to be done as shown by Permit Number P20150328
has been completed.
Tax Map Number: 523400-302-005-0001-077-000-0000
Location: 4 GREENWAY Cir
Owner: SHIRLEY A FREEMAN
Applicant: SHIRLEY A FREEMAN
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the /J /
property owner of the responsibility for compliance with Site Plan, fd
Variance, or other issues and conditions as a result of approvals by the
Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
0111111tai
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
WO
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150328 Application Number: A20150328
Tax Map No: 523400-302-005-0001-077-000-0000
Permission is hereby granted to: SHIRLEY A FREEMAN
For property located at: 4 GREENWAY Cir
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: SHIRLEY A FREEMAN
4 GREENWAY Cir Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
SANITARY SEWER
GEORGE DRELLOS 792-7257
PO BOX 224
GLENS FALLS NY
Plans&Specifications
BP 2015-328
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,July 27, 2016
(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 d.te.)
Dated at the T wn of ee ud 4 /
f day,July 27,2015
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT Office Use Only
DATE Received
Tax Map ID
TAX MAP ID Z I L.cD" "1---- "
ermit No. i24 15- 3 A g
P1 ,• ,i 2 A 2015 i +I 1 ermit Fee LC ' 't-1 X32
���
LOCATION OF INSTALLATION Approvals:
�j _ "-----Al., �- `-INSBURs
APPLICANT �// i,- - (�1 e /r't it yt/ODES PHONE/E-MAIL
ADDRESS l N 6,,./'� �(/tle
INSTALLER/BUILDER: f `/ f
`vc"2 "` , fee PHONE/E-MAIL 7q02 -- 72f 7
ADDRESS: -l/- 0 x 2 2 �l
OWNER c/ -S 7C111C " /2J 7 PHONE/E-MAIL
Address if ( -t eea),% J/7-0 (2/fc le
Ur , ..CONTACT PERSON FOR BUILDING&CODES COMPLIANCE; 0, G I�J �J PHONEL —576c)
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older '-S_ c "L- Garbage grinder installed _YLN
1981-1991 Spa or Hot Tub installed _Y "`N
1 992-Present
PARCEL INFORMATION
Topography k Flat rolling Steep slope %slope
Soil Nature N Sand Loam Clay Other
Groundwater At what depth? A-/4
Bedrock/Impervious Material Attwhat depth? /�/�
Domestic Water Supply -/Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: /' S per minute per inch(test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size �d?'V gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length_/y�, ft.;Each trench `:/5- x y. t•---'1 S"-/r
Seepage Pit with#8 stoney How any: ;size
Alternative System Bed or a type?
Holding Tank System Tot 1 required ca city? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer
allow systems to be covered until such time as an As-Built plan is received&approved. The Installed system must match the septic system
layout on file-no exceptions.
DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or
failure to make a material fact or circumstance know by or on behalf of an applicant, shall be void. I have read the regulations
and agree to abide byibese and all r uireme,pts of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: ( Qi� l�f' Date: S 2 `/- /$
Signature: ��1 � -%�� " ��� Date: r• 2 a> t )'
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
Queensbury Building & Code Enforcement
Office No. (518) 761-8256 1
II Septic Inspection Report
Inspection request received: el 15 L 2OS
Name: —FirgitinnOuiel Inspected on: 8 _
Location: '1 glyzuNAlaii Arrive: Ag�
Permit No.: ;'"2— Inspector's Initials: 4`
Comments and/or diagram
Soil TypeAand /Cly
Type ofV1ater�,IVt'Unnicipal/ ell Water c �D A s�
para
Waterline setion distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+/- Y N N/A
[150'to well required if NO]
Absorption Field: Total length kg r ft.
Length of each trench
h
t
Depthofrences ft. , '�-
-� C\k A Q �'PIL �` t N,A Isk 2
Size of Stone 7Z,
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank l w
Tank to Distribution Box t.4'o Q
Distribution Box to Field/Pit Li " 59C— 3�
Opening Sealed:
End CapDW
P
Inlet/Outlet Pipes&Baffles
Manholes 12"or less below grade N /
[provide extension collar if Yes] Y
Location/Separations
Foundation to tank VO ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan N
Engineer Report and As-Built Y N
ETU Maintenance Contract provided Y N
Location of S stem on Prose :
Front Re. Left Side Right Side Middle Front Middle Rea
S stem Use Stat :
V Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
S1 fe 5 Fr,--e_r" 14v
FILE COPY
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HI' SIGNATURE DATE-- �'
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BUILDING & C*D. s . ' '
Reviewed By: hei
! Date: MI
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TOWN OF QUEENSB
RY
BUILDING& CODE.
1
I Shirley Freeman BP 2015-328
4 Greenway Circle
LI G tee wA ti rt It Residential Septic Alteration