BOTH-000168-2016 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-000168-2016 Date Issued: Friday, June 3, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000168-2016
has been completed.
Tax Map Number: 309.11-1-28
Location: 21 GARNER ST
Owner: RUSSELL LEIGH II
Applicant: RUSSELL LEIGH II
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the _ t/SB4
property owner of the responsibility for compliance with Site Plan, aavvakk" @@@
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 QLJL;EN SBURY
742 Bay Road,Queensbury,NY 12804-5904 (S 18)761-8201
� Community Development- Building& Codes (S 18)761-8256
BUILDING PERMIT
Permit Number: Boni-cloo 168-2016
'Fax lMap No: 3049.1.1-1-28
Permission is hereby granted to: Bradley's Septic;
For property located at: 21 GARNER ST
In the Town of Queensbury,to construct or place at flue above location in accordance with application together
with plot plans acrd other information hereto filed and approved and in compliance with the NYS Uniform
Building Codes acrd[lie Queensbury Zoning Ordinance
Type of Construction
Owner Name: RUSSELL LEIGH 11 Septic Disposal $0.00
Owner Address: 21 ("warner ST Total'Value $0,00
Queensbury,NY 12804
Contractor or Builder's Nance!Address Electrical Inspection Agency
Bradley's Septic
47 Hack 12D
Corinth,NY 12822
Plans&Specifications
llesidential.Septic Alteration
$40.00 PER w1I"N FEE PAID-']'HIS PfriRNVF EXPIRES: Sunday,March 26,2017
(1.1'a longer period is required,an application for air extension must be made to the code 1 nforcement Officer
of the Town of Quecirsbury before tlra e;x 'rection date,)
Dated at the 7"owrorn of ueensb r I;`lreir dry rc 1,2016
SIGNED BY: w for file]'own of Queensbury.
Director ol'Building&Cade Ijnforcenrent
SEPTIC DISPOSAL APPLICATION Office Use Only
Deceived
DATE: j" �, Tax Map ID
TAx MAP ID: ,.� �
Permit No. �%a 2,c l w,
Perini#.Fee 4' .,
ZONE:
APPLICANT PHONE/E-MAIL _. � .
ADDRESS
INSTALLER/ PHONE/E-MAIL
BUILDER
v
_.
OWNER
ADDRESS t
`11 ? w It�
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE:
PHONE/E-MAIL WAD
RESIDENCE INFORMATION i
Year Built #of bedrooms x gallons per bedroom =total Dally flow E BUILDil & Cobh
1980 or olderr Garbage grinder installed _Yes N
1981-1991 Spa or Hat Tub installed _"des
1992-Present
PARCEL INFORMATION
Topography Flat rolling Steep slope %Slope
Soil Nature Sand Loam --Clay Other
Groundwater At what depth: .
Bedrock/Impervious material At what 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 engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRICTION
Tank size gallons(rain.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 i1.;Each Trench
Seepage Pit with 43 stone How many. ;Size
Alternative System Bed or other type: 275 hXk
Holding"yank System Total required capacity?12_< Tank size
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.
4
PRINT SIGNATURE:: Z DATE: .
DATE:
Town of Queensbury Building'&Godes Principal Structure Application Revised September 2014
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