2014-272 TOWN OF QUEENSBURY
ea,
` O 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
. BUILDING PERMIT
Permit Number: P20140272 Application Number: A20140272
Tax Map No: 523400-295-013-0001-004-000-0000
Permission is hereby granted to: JOSEPH& SUSAN COMBS
For property located at: 15 EASY St
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: JOSEPH & SUSAN COMBS Alteration lteration Residential
15 EASY St
Total lt
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
MORNING STAR SEPTIC
793-2290 744-8139
107 JEWELL Rd
GANSEVOORT NY 12831-0000
Plans&Specifications
2014-272
Septic Alteration Residential
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,July 01,2015
(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 Tows,tof22t� erns-b([[gy,; -Jf T esd ,July 01, 2014
SIGNED BY l �'t`K �9 for the Town of Queensbury.
Director of Building& ode E orcement
-411a, TOWN OF QUEENSBURY
742 Bay Road, NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140272 Date Issued: Monday, July 07, 2014
This is to certify that work requested to be done as shown by Permit Number P20140272
has been completed.
Tax Map Number: 523400-295-013-0001-004-000-0000
Location: 15 EASY St
Owner: JOSEPH & SUSAN COMBS
Applicant: JOSEPH & SUSAN COMBS
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, ! 64.4 4.
Variance, or other issues and conditions as a result of approvals by the Director of Building&C `nnf. t.ement
Planning Board or Zoning Board of Appeals.
Office Use Only :u
Town of Queensbury Building & Codes
Received: �� 1 t 1
Tax Map ID: 1 (1 % 4, </
SEPTIC DISPOSAL PERMIT
Permit No.: '11qy'
A permit must be obtained before beginning construction Permit Fee: $
of
Approvals:
Applicant: Installer/Builder
Address: 7l __„"k AAddress
r
Phone: '79 ?22 t —)//v e 1 3 Phone
Owner: Location of Installation
Address: /S ST
Phone A60 sS"Z/
Contact Person for Building&Code Compliance: Day Phone:
Residence Information:
Year Built #of Bedrooms x Gallons per bedroom =Total Daily Flow
1980 or older x 150 = Garbage Grinder installed? .r/
1981-1991 `Z x 130 = C Spa or Hot Tub Installed?
1992—Present x 110 =
Parcel Information:
Topography Flat Rolling _Steep Slope %Slope
Soil Nature < Sand Loam Clay _Other
Groundwater At what depth?
Bedrock/Impervious Material At what depth?
Domestic Water Supply _Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate- per minute per inch(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 /..tec gallon(minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub
System Type: Absorption Field(with#2 stone) Total length ft. Each trench X
Seepage Pit(S)(with#3 stone) How many? QSize? Q i
Alternative System Bed or other type?
Holding Tank System Total required capacity? Tank size? #of tanks?
NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified Electrical form
on Town website; 2) Effective as of March 23, 2006 Septic System-As Built Plot Plan: The Building Department will no longer allow systems to be
covered until such time as an As-Built Plot Plan is received and approved by the Building Inspector. The installed system must match the septic system
layout on file. There will be no exceptions.
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. (�..�. n
Print Name: ''�r'.p i'/� L;ti ��'�1 w Date: CCC///1J /— /'-/
Signature: `.-4 C • Date: PPP
Town of Queensbury Building&Codes Septic Disposal Permit 518-761-8256
Town of Queensbury Building &Code Enforcement ~--f
Office Pio. (518') 761-8256
Septic Inspection Report
Inspection request received:
Name: ab tc b Inspected on: —
Location: / 5 EQ Si-- Arrive: =��� . a .m.
Permit No.: /'� �� Inspector's Initials:
ments and/or diagram
Soil Typ • San /Clay
Type of Wat pal/ ell Water
Waterline separation distance 1 ft. + FIZC NT `LAa).
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+I- Y N N/A f P, dw
[150'to well required if NO] !. f `.' t
Absorption Field: Total length _ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number 2-
Size:
Size: 1-1 x 1 D
Stone Size: __
Piping Size Type
Building to tank
Tank to Distribution Box Lv" jQl�
Distribution Box to Field Pit
Opening Sealed: Y
End Cap Y_N
Inlet/Outlet Pipes&Baffles —3/V
Manholes 12"or less below grade _Y �-� 51-‘
_< < 1� . -
[provide extension collar if Yes] _Y ✓N
Location/Separations Z_ -9112 C ��
Foundation to tank
Foundation to absorption 71.2CQft.
Separation of Pits ft.
Conforms as per Plot P
Engineer Report a P. As-B ' Y_N
ETU Maintenanc "ntract provided Y N
Location of S stem on Property:
Front Re=Left Side Right Side Middle Front Mi dle Rear
ystem Use Sta . :
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Septic Inspection Report
e
- • - e . • 518-793-2290
Fax#518-793-2115
:.3 8 5 ® - i i E-mail: morningstarseptic@hotmail.com
"` ' a- www.morningstarseptic.com
=7111MIPTIC SURVIC$
Date: -1 ' 107 Jewel Road,Gansevoort, NY 12831
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I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, -ENCES, ETC
SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY
• OWN 4F OU E , MEASURE ANC ORTH ON THIS DIAGRAM
BUILDING IGNA"PURE _/_
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Reviewed
Date: rf. I -1 '