SEP-000361-2017 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: SEP-000361-2017 Date Issued: Monday, July 3, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000361-2017
has been completed.
Tax Map Number: 309.11-1-2
Location: 215 FIFTH ST
Owner: Steven Burch
Applicant: Smith's Excavating
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
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 8r.Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804.5904 (518)761-8201
Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000361-2017
Tax Map No: 309.11-1-2
Permission is hereby granted to: Smith's Excavating
For property located at: 215 FIFTH 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
Tvceof Construction
Owner Name: Steven Butch Septic Disposal-Residential $0.00
Owner Address: 215 FIFTH ST Total Value $0.00
Queensbury,NY 12804
Contractor or Builders Name/Address Electrical Inspection Agency
Smith's Excavating
23 Vermont AVE
Queensbury,NY 12803
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-TIES PERMIT EXPIRES: Friday,June 29,2018
(If a longer period is required,an application for an extension must he made to the code Enforcement Officer
of the Town of Queensbu before yextiondate.)Dated at the Town of ueensbThur e 29,21SIGNED BY: V for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only
Tam74 742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.oueensbury.net Permit#: 3/c1r�017
Tax Map ID#: /f/—/— Permit Fee:$ ° Invoice#:
Project Location: S Septic Variance? Yes No
PrimaryOwner(s) (e-12 U
Mailing Address r 47 u(w AA 47
Phone& Email
Installer/Builder
Mailing Address C
Phone & Email v d y' D
Engineer C S
Mailing Address 0 1 A/ TQ /QUEENSBU Y
Phone&Email M NT
Contact Person for Building&Code Compliance: Phone: &016 q"�6
RESIDENCE INFORMATION:
Year Built It of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes No/
1980 or older d Installed? (circle one) V
1981-1991 Spa or Hot Tub Yes o
Installed? (circle one)
1992-Present
PARCEL INFORMATION:
Topography Flat Rolling _Steep Slope _%Slope
Soil Nature _Sand _Loam _Clay _Other
Groundwater At w at depth?
Bedrock/Impervious-material At hat depth?
Domestic Water Supply _Municipal _Wcflf(if well,water supply from any septic system absorption is_ft.)
Percolation Test Rate: per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size gallons(min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length ft.; Each Trench ft.
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 and approved.
The installed system must match the septic 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 fad 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: DATE:
SIGNATURE: DATE:PI
Town of Queensbury Building&Code Enforcement Revised February 2017
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CENTER PROJECT
SERVICES
73 Sheridan Street, Glens Falls,NY 12801
Phone-518-796-2515
June 9, 2017
ECOMMU,Nli-y'
�}� Project#257
Fred Smith jI I
Smiths Excavation ,
Queensbury,NY 12804
Re: Proposed Replacement Septic UEEMSSURY
215 Fifth Street, Queensbury,NYnEVELOPMENT
Dear Fred:
At your request, we have reviewed your proposed replacement septic system design of the
existing 2-bedroom house at 215 Fifth Street in Queensbury. As per our conversation the
residence has an existing failed septic system.
We have reviewed the proposed replacement septic system design and we agree that a standard
absorption bed is acceptable. Based upon a design flow rate of 220 GPD and a percolation rate of
1 to 5 minutes, you will need a minimum of 232 sf of absorption area. We recommend using 15
ft wide by 20 ft long absorption bed with 3 - 15 R long laterals. The absorption system can be
constructed with the existing 1,000-gallon septic tank, new distribution box, and 4-inch diameter
perforated pipe and stone.
Please feel free to contact me at 796-2515 if you have any questions and that you for your
assistance with this request.
Sincer y,
Thomas R. Center Jr, P.E.
309.11-1-2 SEP-000361-2017
Burch, Steven
215 Fifth St.
Residential Septic Alteration