2012-571 .11a. TOWN OF QUEENSBURY
IF. 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120571 Date Issued: Thursday, November 10, 2016
This is to certify that work requested to be done as shown by Permit Number P20120571
has been completed.
Tax Map Number: 523400-308-016-0001-017-000-0000
Location: 20 STEPHANIE Ln
Owner: GARY & MARY SAWYER
Applicant: GARY& MARY SAWYER
This structure may be occupied as a:
Septic Alteration Residential
By Order of Tonm Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the (- 414P 4
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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: P20120571 Application Number: A20120571
Tax Map No: 523400-308-016-0001-017-000-0000
Permission is hereby granted to: GARY& MARY SAWYER
For property located at: 20 STEPHANIE LII
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: GARY& MARY SAWYER
Septic Alteration Residential
20 STEPHANIE Ln
QUEENSBURY,NY 12804 Total Value
Contractor or Builders Name/ address Electrical Inspection.Agency
NIMS OUTDOOR SERVICES
CHAD NIMS 232-2501 CELL
1546 STATE ROUTE 196
FORT EDWARD NY 12828-0000
Plans&Specifications
2012-571
Septice- Res. alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,December 04,2013
(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 Queensbury; Tuesday,December 04,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
k ',^ Community Development Office
,-/ Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only
TAX MAP NO. 3OS_(�o - 1 - t.7 PERMIT NO. /c"):- 5I) I PERMIT FEE c-lb 9.1'-
APPROVALS:
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW
A BEFORE ISSUANCE OF A VALID PERMIT.
U(
OWNER: t CI '. (Yk�i Suw1� INSTALLER: IV xmS Ol.+&occC cC -u\uLl
ADDRESS: 20 S ,c L.ui\& 6),(4.1_,Sb-it ADDRESS: `S 4 CO S(L \q la I Fo r ak t t/C1 y l2i 2
PHONE NOS. 232 -ZSO l PHONE NOS. 7`"( 1 - SZ-9
LOCATION OF INSTALLATION: ZO C-I-C-efiv6 Q LU✓UL I ("OV.B.2Aj 6.v./e›, ' J* 1 MLA
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) , GARBAGE GRINDER
1980 or older X 150 = INSTALLED? WC
1981 -1991 3 X 130 . = . 3 0 SPA OR HOT TUB
1992-present X 110 =
INSTALLED? N O
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING k STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND k LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL X (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpi] (Test to be completed by a licensed professional
engineer or architect)
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).
TANK SIZE: (000 GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa or whirlpool tub. l
SYSTEM TYPE: � /4G
-. eP VJ
.�
❑ABSORPTION FIELD(WITH NO. 2 STONE) Total length ft. Each trench X
❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL
INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
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 QUESTIONS? CALL 761-8256 OR EMAIL
aoage Disposal Ordinance. codesOqueensbury.net
/2-y--1 Z VISIT OUR WEBSITE FOR MORE INFORMATION
Person Responsible Date www.queensbury.net
Sk ak Iks
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection r-• :t"•r.. e' ed:
Queensbury Building &Code Enforcement Arrive: :- VT Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's In' -
NAME: Liar N'\ca,-3 S Q u:3 E';' PE' 1T NO.: I
LOCATION: v✓ f.)h r,V, IN ECT ON:
RECHECK:
Comments and/or diagram
_ Soil Type: Sand/ Loam / Clay _
Type of Water: Municipal / Well Water
Waterline separation distance ft. IA-41-/ 3
Well separation distance ft. '1
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 ft.
Depth of trenches ft.
Size of Stone (w``°
Seepage Pits: Number VC-.).°C'
Size:
Stone Size:
Piping Size Type
Building to tank � 12 1-%:\
Tank to Distribution Box
Distribution Box to Field / Pit
Opening Sealed: _Y T N
End Cap _Y N
Inlet/Outlet Pipes& Baffles TY N
Manholes 12"or less below grade _Y_ N
[provide extension collar if Yes] _Y N
Location/ Separations
Foundation to tank Jp ft.
Foundation to absorption ft. Chi t�
Separation of Pits ft.
Conforms as per Plot Plan _ N
Engineer Report and As-Built Y N
ETU Maintenance Contract _Y_ N
provided
Location of System on Property:
Front OOP Left Side Right Side Middle Front Middle Rear
S stem Use 5ta s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report03 29 10.doc
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-- ° < I HAVE SEEN OR OBSERVED ALL OBJECf5
< °z a SUCH AS HOUSES,WELLS,TREES, FENCES, ETC
Z < N W SHOWN ON THIS OOO�dA'I T I HAVE PERSONALLY
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NOTES: 341 ,_ ,} _ 36
I. MAP REFERENCEI"MAP OF A PROPOSED \ �"� u LTWUUO I y`
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SUBDNISION OF LANDS OF WALTER DOMBEK" T ,,, %,o Vii\
BY COULTER a MOCORMACK, DATED IALLQi.-, D-I- cORCH -
SEPTEMBER 28, 1980 Fee_ 0
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CERTIFICATIONS SHALL RUN ONLY TO THE PERSONS FOR WHOM THE
SURVEY IS PREPARED. AND ON THEIR BEHALF TO THE TITLE COMPANY
. GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON
AND TO THE SUCCESSORS AND ASSIGNEES OF THE LENDING INSTI.
. TUTION CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL
INSTITUTIONS OR SUBSEQUENT OWNERS
THE CERTIFICATION OF THIS MAP AND SURVEY IS NOT SURVEY OF
VALID UNLESS SIGNED AND SEALED WITH AN L 0 T 3 5
IMPRESSION SEAL.
UNAUTHORIZED ALTERATION OR ADDITION TO THIS1111 MAP OF A PROPOSED SUBDIVISION OF LANDS OF
SURVEY MAP IS A VIOLATION OF SECTION 7209 (2) OF WALTER DOMBEK
THE NEW YORK STATE EDUCATION LAW.
N COUNTY:
0 DATE PROPOSED HOUSE LOCATION FOR TOWN OF QUEENS BURY WARREN ,
r 2/23/87 GEORGE KOSHOARIAN, , N.Y.
10 o 3/6/87, PROPOSED
KOSHGAIRIAN C STEM ADDED FOR 11 -7.
, GATE
SCALE; I 30 FEBRUARY 23, 1987
PROPOSED IMPROVEMENTS ADDED FOR /
cT I, 4/Z0/87 GEORGE KOSHGARIAN �y
4 o PROPOSED IMPROVEMENTS ADDED POR Nailed ?JohnDixt�artttne
C7 5/4/87 GEORGE KOSHGARIAN LICENXED LAND 1011VEYOR•LAND PLANNING
Z 0 BALLSTON SPA-NEW YORK-12020
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2 et LIC. NO.:
87-
m ROBERT J. MacFARLANE P.L.S. 44229 NO. 33-S
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