2014-575 TOWN QUEENSBURY
- - OF
742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140575 Date Issued: Friday, November 14, 2014
This is to certify that work requested to be done as shown by Permit Number P20140575
has been completed.
Tax Map Number: 523400-302-005-0001-059-000-0000
Location: 15 GREENWAY NORTH
Owner: JERRY & LINDA STEVES
Applicant: JERRY & LINDA STEVES
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 uilding&Cod :nforc�k,ent
Planning Board or Zoning Board of Appeals.
1� TOWN OF QUEENSBURY
` i � 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140575 Application Number: A20140575
Tax Map No: 523400-302-005-0001-059-000-0000
Permission is hereby granted to: JERRY& LINDA STEVES
For property located at: 15 GREENWAY NORTH
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: JERRY& LINDA STEVES
15 GREENWAY NORTH Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY.NY 12804
Plans&Specifications
BP 2014-575 Steves
Septic Alteration -Tank Replacement ONLY
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,November 12, 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 tyf tsbut Wed u s d y,November 12,2014
SIGNED BY �C—/ '� for the Town of Queensbury.
Director of Building&Co.e Enfo ement
SEPTIC DISPOSAL PERMIT J '—
,/ Office Use Only
DATE ( l /a-- ?-o i ,/ Received I^"UV' D"'a"ai 7
Tax Map ID
TAX MAP ID3o).,04- - NovPermit No. 0 l i Z S /
e � C,� � � `� 40�rmit Fee I i
I N ^ , e Wi�
LOCATION OF INSTALLATION 1 SC(' (-&-) 1 o rr Approvals: ' -
APPLICANT 1-1:f ) S-e Q P I •
PHONE/E-MAIL 1 Ic.rj 0 1 l I
ADDRESS -) _, kOW (r VV J1('(?r. 1,4 . 01i11't.. OoV' ( `'
INSTALLER/BUILDER: B J S,Q 0- ( Cr PHONE/E-MAIL 1 () 6--%\ 9
ADDRESS: 2\(NV e ( u"✓A( (Pr,- S� . a Ae r• SolA ' --'1
OWNER 1.-- I r CA (A ��Pe__- t L PHONE/E-MAIL
Address t & ' , W 01 N b -L
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: PHONE
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older 3 \ Garbage grinder installed _Y JN
�J V
1981-1991 I \ I N Spa or Hot Tub installed _Y ./N
1992-Present v\ �� k \V��
PARCEL INFORMATION l
Topography Flat rolling ( Steep slope \ %slope
Soil Nature /Sand I Loam \\I \-Clay V A Other
Groundwater At what depth?
Bedrock/Impervious Material At whyt depth? ��
Domestic Water Supply Municipal LV Well (if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: \V r\ per minute per inch (test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size Inc 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 Nf r\ ft.; Each trench N J x \') ft
\f 1\ Seepage Pit with#3 stone How many: V i ;size N I�
NN Alternative System Bed or other type? N !�
\\\(,) Holding Tank System Total required capacity? 1\ \ Tank size IV N #of tanks N N-
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 byhese and all requ em nts of the Town of Queensbury Sanitary Sew a ispotI Ordinance.
Print Name: ( 'iff"(�k� hell Date: I � �`
Signature: \--e-jtr) — Date: 11–I/..J t1
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
.i own of Queensbury Building &Code Enforcement D.Nst/E; ?iv
Office No. (518) 761-8256
Septic Inspection Report `A)
Inspection request received: 1 1 • (s va
Name: S gW1-1 v /ax"71 Inspected on: 11 /a. I
Location: 15 6peeiNt.3eq /\)O(i' Arrive: fck_./ a.m./p.m.
Permit No.: X14,5 i5 Inspector's Initials:
Comments and/or diagram
Soil Type: Sand 1 Loam I Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft. _ 1 )
2
Well separation distance ft. �J L�
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
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank (r
Tank to Distribution Box iv-pe
Distribution Box to Field/Pit
Opening Sealed: /16 Y 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
Location/Separations
Foundation to tank /0 ft.
Foundation to absorption _ ft.
Separation of Pits ft.
Conforms as per Plot Plan <TY^.N
Engineer Report and As-Built Y N
ETU Maintenance Contract provided Y N
Location of System on Rcoperty:
Front Rear-'i Left Side Right Side Middle Front Middle Rear
System Use Status:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
Steves BP 2014-575
IBS Septic
15 Greenway North
�-- Tank Replacement ONLY
(\ �K o \)/
SEPTIC PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY
ME/Or/ !!STANCE SET FORTH ON THIS DIAGRAM.
NOV 12. 2614 siGNAr f..- 1H)-1`DAT
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