BOTH-000519-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
at Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000519-2016 Date Issued: Friday, August 12, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000519-2016
has been completed.
Tax Map Number: 309.6-2-80
Location: 15 NORTHWAY LN
Owner: Wayne Flagg
Applicant: Straight's Septic Service
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN
^OF QUEENSBBURY/�
Issuance of this Certificate of Compliance DOES NOT relieve the `. / ,- f/ �,J
4t
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 12804.5904 (518)761-8201
qW Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000519-2016
Tax Map No: 309.6-2-80
Permission is hereby granted to: Jack Straight
For property located at: 15 NORTH WAY LN
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
Tvce of Construction
Owner Name: Wayne Flagg Septic Disposal $0.00
Owner Address: 15 Northway LN Total Value $0.00
Queensbury,NY 12804
Contractor or Builders Name/Address Electrical Inspection Agency
Straight's Septic Service
I Myron AVE
South Glens Falls,NY 12803
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,August 4,2017
(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 expp. ion/date.)
Dated at the Town of ueensbu , ( / /Tues y st 9,2016
SIGNED BY: (�,'VXl/ �VJ for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL APPLICATION Office Use Only
Received
DATE: AUG C'3 2016 Tax Map ID
TAX MAP ID: Permit No.
ZONE: Permit Fee t �(�. (it)
APPLICANT S r� /'U[9C - PHONE/E-MAIL
ADDRESS
INSTALLER/ .S+�rA�,��f--r •`�' Qry PHONE/E-MAIL
BUILDER ,qE-(c 3; Sf> l,�l _
OWNER Gv fttvE F/
ADDRESS S V.Orfi.w L+a ( uBaNl�i�✓ _`� /Zd�o
CONTACT PERSON FOR BUILDING&C DE COMPLIANCE:
PHONE/E-MAIL
RESIDENCE INFORMATION
Year Built #of bedrooms X gallons per bedroom =total Daily flow
1980 or older Q 3 -?O Garbage grinder installed Yes t&IO
1981-1991 Spa or Hot Tub installed Yes AlNo
1992-Present
PARCEL INFORMATION
Topography -a Flat rolling _Steep slope _%Slope
Soil Nature 10Sand _Loam _Clay _Other
Groundwater At what depth: fVax�e
Bedrock/Impervious material At what depth: kPKA-
Domestic Water Supply Municipal Well(if well,water supply from any septic system absorption is_ft.)
Percolation Test Rate: m;u 35- per minute per inch(test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank size 80 Ogallons(min.size 1,000 gallons,add 250 gallons to size for each garbage cylinder or spa or hot tub
System Absorption field with#2 stone Total length-900 ft.;Each Trench SD
Seepage Pit with#3 stone How many: _;Size
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 known 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: ACK I.J7a^i4d l Y. i IIS LDATE- Z. �o
SIGNATURE: ATE: z -lo
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Town of Qu bury Building&Codes Principal Structure Application Revised September 2014
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SEPTIC PLOT PLAN
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Flagg, Wayne
15- NoAwp,%�' LANA_ 15 Northway Lane
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NOT Ori 5c-Ole-
G.Peter Jensen
17 West Road
South Glens Falls
New York 12803
(518) 798—3859
July 23,2016
To Whom It May Concern:
I have performed a percolation test and reviewed a test pit dug at the Wayne Flagg
residence located at 15 Northway Lane, Queensbury, Warren County New York. The test
pit revealed:
• 0-5"top soil.
• 5"-20"brown medium sand.
• 20"-32"orange brown medium coarse sand.
• 32"-62"gray coarse sand.
• No evidence of mottling was observed.
The percolation test resulted in a stabilized percolation rate of 1 minute 35 seconds.
Sincerely,
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