2014-497 TOWN OF QUEENSBURY
%I N 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140497 Application Number: A20140497
Tax Map No: 523400-309-007-0001-007-000-0000
Permission is hereby granted to: EDWARD & SARAH HERMANCE. LE
For property located at: 15 HOLDEN Ave
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: EDWARD & SARAH HERMANCE, - Septic Alteration Residential
LIZCAR LLC Total Value
26 PEGGY ANN Rd
QUEENSBURY NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2014-497
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, October 08,2015
(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 Town f Que sb A W:i e e t�,a October 08,2014
SIGNED BY �r.r- 4\ for the Town of Queensbury.
Director of Building& Code Enforcement
TOWN OF QUEENSBURY
Foy742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140497 Date Issued: Monday, October 27, 2014
This is to certify that work requested to be done as shown by Permit Number P20140497
has been completed.
Tax Map Number: 523400-309-007-0001-007-000-0000
Location: 15 HOLDEN Ave
Owner: EDWARD & SARAH HERMANCE, LE
Applicant: EDWARD & SARAH HERMANCE, LE
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 f/ 4 4e5t.
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.
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SEPTIC DISPOSAL PERMIT ---------` v !
Office-Us,
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DATE l�—T• 7 ,)01 ri IReceise�f fax Map ID t3oq. r7 + 7
TAX MAP ID Permit:NO:31e- ...-<-
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LOCATION OFINSTALLATION B--Aper-o s:
APPLICANT PHONE/E-MAIL
ADDRESS - U�
INSTALLER/BUILDER: d I 1 errActv.c P PHONE/E-MAIL ` ,.,
ADDRESS: / S 17ofdetA /lt UtLi-e Qll-e �e SIOCI Ilv tL�./ -�oV
OWNER < PHONE/E-MAIL S t- 7? �-t>% 7/
Address J ��� }� J ✓1l l
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: S1'9k 14 I4 tLYG't/v L f PHONE 79>-d'S7I
RESIDENCE INFORMATION \MTDaS1 � �T
' lE^ �R1ss3L, F`C. k,? ¶ 7. 00?........Year Built list #of bedrooms 1XFHG�Iaallll000nss per bedroom `C=Total Daily Flow
1980 or older t t t o It, -- Garbage grinder installed _Y _N
1981-1991 Spa or Hot Tub installed _Y _N
1992-Present
PARCEL INFORMATION /
Topography V�/Flat rolling _Steep slope %slope
Soil Nature 17 Sand Loam Clay Other
Groundwater At what pth?
Bedrock/Impervious Material At w t 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 licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size tact at s 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 l t ft.; Each trench 6— x 1`11 p
Seepage Pit with#3 stone How many: ;size t- W LVUYE
e
Alternative System '. Bed or other type?
Holding Tank System Total required capacity? 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 by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: Date:
Signature: ELVer. .A A otAar Date: D ci-• Ti" ?-0 (`I
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
Town of Queensbury BuiIc f g & Code Enforcement
Office No. (518) 761-8256
Septic Inspection Report
Inspection request received:
Name: r/ a/'rn4gd. e Inspected on:
Location: 15 1+0 telt'A Pro >,? Arrive: 114A° a.m./p.m.
Permit No.: 1<i-z-A / Inspector's Initials:
Comments and/or diagram
Soil Type: a Loom I Clay
Type of Water: unicipal Well Water
Waterline separa n istance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+/- Y N_NIA
[150'to well required if NO] get.-M--rdQkier
Absorption Field: Total length 1,?c`ft. olz 't >,
Length of each trench n ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size x Ot (Pt
Stone Size:
Piping Size Type
Building to tank F'__` ailjaa-
Tank to Distribution Box �� f„_iyyy„'
Distribution Box to Field I Pit /�'c ZVZ--3<PelZi
Opening Sealed. N
End Cap �Y N
Inlet/Outlet Pipes&Baffles ✓Y N
Manholes 12"or less below grade _Y_N
[provide extension collar if Yes] Y N
L,
Location 1 Separations \ -
Foundation to tank ft.
f ` .
Foundation to absorption ' .0k t. 1
Separation of Pits ft. \
Conforms as per Plot Plan /N J 1
Report and As-Built Y N c-
Engineer //J
ETU Maintenance Contract provided _V_N
Location of S ste in Pro• :
Front Cleft Side Right Side Middle Front Middle Rear
System Use Sta
Approv
Pa ial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Septic Inspection Report
RECFRIE.D
JUL 0 3 2000
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Based on our limited e.Lmina'
compliance-with our com II
not be construed as indicating the
Plans and specifications are in hull
compliance with the code. \
•
TOWN OF QU, ENSBUR "I have seen or observed, or believe 1 saw evidence of,
all objects such a ousel, wells, tires, fences, etc.,
BUILDING & O •. on this i.al///+ r: resent that ! have
REVIEWED B i' i T' terse ally me. .r 'es set forth on th• diatram-"\iii
DATE AZ? N J 1
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1 SI N, URE +ATE
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