2014-338 TOWN OF QUEENSBURY
ow742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140338 Date Issued: Monday, July 28, 2014
This is to certify that work requested to be done as shown by Permit Number P20140338
has been completed.
Tax Map Number: 523400-295-019-0002-030-000-0000
Location: 4 LYNNFIELD Dr
Owner: ELEANOR SHAW, LE
Applicant: MICHAEL SHAW
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
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals b he ���'�
yDirector of Building& Code "nforee tent
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20140338 Application Number: A20140338
Tax Map No: 523400-295-019-0002-030-000-0000
Permission is hereby granted to: MICHAEL SHAW
For property located at 4 LYNNFIELD Dr
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: ELEANOR SHAW,LE
MICHAEL& PETER SHAW Septic Alteration Residential
28 FOX FARM Rd Total Value
QUEENSBURY NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: WAN BELL
2 LOWER WARREN St
OUEENSBURY,NY 12804
Plans&Specifications
2014-338
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,July 28,2015
(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 Qu e sbu 4 i ,d . •- 28,2014
.i
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
sisk ill
SEPTIC DISPOSAL PERM
it � 'O'f''fic4 Use Only
DATE iULIj JUL 28 2014 j4, ived
I TO OF Taxpap ID .. a G}—_ — a
TAX MAP ID QUEENSBURfPe it No. A =
_ RI ur — -& CODES Y�
/�/ / ` "-- --.Perrrmit Fee A
LOCATION OF INSTALLATION I/o� �( Approvals: i /
APPLICANT - ' 1 i ( t ¶(, / 6 l_ PH /E-
ONEMAIL /6C !'(�C �iC�ru�J(44y+ADDRESS a OLaf ( Joire vS7 a6�j -' t/ ✓ /
INSTALLER/BUILDER: 1?t 5. 5 �/9/ !C — PHONE//E--MAIL /6 - &•,:y621://-6.1.
ADDRESS: ! _ i a Cr el, 41141 _ .
OWNER 71i , (ftr Seo v_ L„...) PHONE/E-MAIL SAM
Address /1��
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: - '1/4 [3"C-L f PHONE
RESIDENCE INFORMATION
Year Built -#-of bedrooms X Gallons per bedroom =Total Daily Flow
1980 orolder 7 j `✓` L/
b--�
0 (, Garbage grinder installed _11 N
1981-1991 Spa or Hot Tub installed _Y 1-N
-
1992-Present
PARCEL INFORMATION
Topography Flab rolling Sleep slope %slope
Soil Nature Sand Loam ,} Clay Other
Groundwater At what depth? /P]
Bedrock/Impervious Material t what depth? SAV 4
Domestic Water Supply Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: /],4, per minute per inch(test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION / "
Tank Size /0a0 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 -ft.;Each trench x .
—
Seepage Pit with#3 stone How many: ;size
Alternative System Bed or other type?
Holding Tank System Total required capacity? Tank size #of tanks _
Notes: 1).Alami 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—ho exceptions.
DECLARATION: My 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 by th - d all requireme o the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: GC v C ryt L Date:
Signature: G %14/L Date: )/'1 r Ac' ! 1y/Q 6
Town of Queensbury Building&Codes Principal Structure Application July 2014
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: 7 / 2-30(i
Queensbury Building&Code Enforcement Arrive: amzrt am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials•/���n�� o
NAME: IL i 5/5k PERMITNO.: 1l
LOCATION: 1/ L y v- p l Ii DC INSPECT ON: M7
RECHECK:
Comments and/or diagram
Soil Type::Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation 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 ' ft.
Length of each trench
Depth of trenches tit_
Size of Stone d
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type <RR✓,il�,l7 . ,Q nip
Building to tank �41�A I_ �I " 6
Tank oDxtFBox It <nylc
DistributionnBox to Fieldeid/ Pit l "w
Opening Sealed: _Y N
(x` t,\-1 •
End Cap • N `51
Inlet/Outlet Pipes&Baffles ^N
Manholes 12"or less below grade _N
[provide extension collar if Yes] Y N
Location/ Separations
Foundation to tank az7 ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan _Y N
Engineer Report and As-Built _Y N
ETU Maintenance Contract _Y_ N
provided
Location of Syste• o • •perty:
Front Rear Left Side Right Side Middle Front Middle Rear
stem U - o, :
. Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam WhiUng\2010\Building Codes Forms r3pe ilon FonrIA5eptic I c ion Repoct.03 29 lot
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TOWN OF QUEEP,d B , YY 33
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BUILDING & f�(;L�t%�E ( It
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Reviewed By: /r libtJ
Date: / ? .v• , 8 2014 D
i JUL 2
TOWN UILDIFNG&CODES Y
SEPTIC PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS l, i y
SUCH AS HOUSES,WELLS,TREES, FENCES, ETC ' 7 I �
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SHOWN ON THIS DOCUMENT.I HAVE PER ONAL Y
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BUILDING & .,OD' di� T, f i,: ,, • :
Reviewed = - h "� JUL 2 8 2014
Date: f_d . t-
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SEPTIC PLOT PLAN
1 HAVE SEEN OR OBSERVED AL! OBJECTS ti H
SUCH AS HOUSES,WELLS,TREES,FENCES,ETC �/(s +
SHOWN ON THIS DOCUMENT.1 HAVE PER ONAL Y 1 b 6 C I n I
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