2001-514 TOWN OF QUEENSBURY
vipis742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010514 Date Issued: Tuesday, July 17, 2001.
This is to certify that work requested to be done as shown by Permit Number P20010514
has been completed.
Tax Map Number: 523400-303-016-0001-017-000-0000
Location: 88 QUEENSBURY Ave
Owner: STEPHEN &DEBORAH STEDMAN
Applicant: STEPHEN &DEBORAH STEDMAN
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010514 Application Number: A20010514
Tax Map No: 523400-303-016-0001-017-000-0000
Permission is hereby granted to: STEPHEN &DEBORAH STEDMAN
For property located at: 88 QUEENSBURY 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: _ STEPHEN&DEBORAH STEDMAN Septic Alteration Residential
88 QUEENSBURY Ave Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
I.B.S. SEPTIC
2 LOWER WARREN STREET
OUEENSBURY.NY
Plans &Specifications
2001-514
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,July 17,2002
(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 own Que b ty; T e> ay,July 17,2001
SIGNED BY { for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System
Town of Queensbury 742 hay Road Queensbury, NY 12804 (518) 761-82.56
I. OWNER INFORMATION:
Location of installation: g f LYV C C, ,9 6-c.,.,-,7 4c.c Office Use �- I 11
J File Permit No.
Tax Map No. / / LI
Owner's Name:(61(.5 le t: /
�Mu n.) Fee Paid
Address: 62(,Cc A/S 0 ' A ,.c
2. INSTALLER'S NAME : iI h e Sr®j i c C
/" PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate ll bedroom(s) and multiply II of
•
bedrooms with applicable gallons per bedroom to equal total daily flv►v)
Year of House: No. of Bedrooms x Computation = Total Daily Flov'RECEIVED
�
1980 or older x 150 gal/bdrm = cl,c1980— 1991 x 130 gal/bdrm = JUL 1 1 2001
1991 —present x 110 gal/bdrur =
y TOWN OF QUEENSBURY
/,
Garbage Grinder Installed yes— / no BUILDING AND CODE
Spa or Whirlpool Installed yes / no
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
Ezra by S•" tore Ground Water Bedrock or Impervious Material D _ atcr Su?ply
at 1 ghat depth a!wl a! epth rnruhictpc
Mg m 0 feet r/ feet w'
Steep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test: (To be Completed by licensed professional engineer or architect)
Rate: minute per inch
5, 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). Add 250 gallons to the size
of the septic lank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: (9Q6 gallon (min. size 1,000 gal)
Tile Field: each trench S,j ft. Total System Length: fi'. ,'rr CircAtd 7
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: It_ / depth or thickness _fret
Bed System Size: • x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
•
Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON (please read)
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.
7—17"dact/r
Sin re of respons le person Date
t_-------, 6:*)
e` TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
•
Name '7/101 A)
Location 8g a)066,v3/bog e x -
Date 7//Z 0 ( P- it # 0CJ67L
SOIL TYPE: and-Loa ' Cy-
Results of Percol at'on Tes\t-
(if applicable)/Rat--Minut-/Inch /
TYPE OF SYSTEM:(ABSORPTION FIELD: j.tal L: gbh gde
Length of each tre - . ' )
Depth of trench
Size of stone rivp/ i� dA____
SEEPAGE PITS: Numbe, -
Size - ft. x ft.
Stone size
PIPING: S?z�e Type
Bldg. to Tank 6Z W 7l
Tank to Dist. Box 0 5,t2
Dist. Box to Field/P.t ti- • IR
Openings Sealed? ), No . ,Partial
LOCATION/SEPARATIO'
Foundation to Tank C� feet
Foundation to Absorption __ feet . .
Separation of Pits • __ i eet
-- _;)
Conforms as per Plot Plan e No
LOCATION OF SYSTEM ON PROP .
(circle one)
Front - Rear - Left Side Right Side
Middle Front - Middle Rear
COMMENTS: . . .
•
' / /)SYSTEM.USE APPROVED: YES NO
Arrived: Ii2,74)Departed: . --P/C. -
Building Inspector
I I I 1 '
"I have seen or o a serve , or Eelieve I saw evidence of 1
- - I
ail objects such a�ho ses, wells, tree, fences et c.,
. shown-on}thisi doaume�nt,also-reresent-that-l-have-- -
pbrsonally - easured the dis �nces set for h_on'thediagram."
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