2005-581 (zt TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERT IFICATE OF COMPLIANCE
Permit Number: P20050581 Date Issued: Friday, July 29, 2005
This is to certify that work requested to be done as shown by Permit Number P20050581
has been completed.
Tax Map Number: 523400-308-020-0001-012-000-0000
Location: 32 STEVENS Rd
Owner: ROBERT L JOHNSON
Applicant: ROBERT L JOHNSON
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 by the Director of Building&Code Enforcement
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: P20050581 Application Number: A20050581
Tax Map No: 523400-308-020-0001-012-000-0000
Permission is hereby granted to: ROBERT I. JOHNSON
For property located at: 32 STEVENS Rd
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. Tyne of Construction Value
Owner Address: ROBERT L JOHNSON
32 STEVENS Rd Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OI TEENSBI TRY_ NY 12804
Plans&Specifications
2005-581
Septic System Replacement due to failure
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, duly 29, 2006
(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 own Quee bunt; my 29, 2005
f }
SIGNED BY 4°^ ''� '' 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: ae vr't'f
1: File Permit No. 15
Tax Map No.
Fee Paid
Owner's Name:
C
.......... ...................................................................................................
Address: &Zj ?yr-v
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 gallbdrm =
1980- 1991 x 130 gal/bdrrn =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes no
Spa or Hot Tub Installed yes no
JUL F, 2005
4. PARCEL INFORMATION: (circle applicable information&indicate measureni
2Maraphy SVANatune Ground Water Bedrock or Impervious Material DommfierWater S4-DRly
Fla j) (sand) aVthgdep th at wbatdepth municipaloiling --16a eet—m .,LlAj et
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). Add 250 gallons to thesize
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 ft. Total System Length:
Seepage Pit(s): number of size ofeach: ft. by ft.
Size of Stone to be used: # I depth or thickness_jeei
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
gallons /TOTAL Capacity:
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 1 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.
Signature of responsible person bate
BUILDING & CODES DE-r*'li
REVIEWED BY
DATE
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JUL 2 8 2005
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T0VVN ONUEENI'SBURRY BUILDING Er",RTMENT
Based on our limited exam ation, ;6
corngliance with our commer, shall
not e construed as indicati g the
plans and specifications are in full
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