BOTH-000082-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
— Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000082-2016 Date Issued: Monday, March 20, 2017
This is to certify that work requested to be done as shown by Permit Number BOTH-000082-2016
has been completed.
Tax Map Number: 309.14-1-68.2
Location: 17 RYAN AVE
Owner: Community Work& Independence,Inc.
Applicant: Community Work& Independence,Inc.
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 r '" %�
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 4F +QUEENSBURY
742 Bay Road,Queensbury,NY I2804-5904 (518)761-8201
Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000082-2016
Tax Map No: 309.14-1-68.2
Permission is hereby granted to: Community Work&Independence,Inc.
For property located at: 17 RYAN 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
Owner Name: Community Work&Independence,Inc. Septic Disposal 50.00
Owner Address: 17 Ryan Total Value 50.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,February 16,2017
(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 expiration date.)
Dated at the Town of Q(9 tridot,2016
SIGNED BY: the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT
Office Use Onlu
DATE Received
Tax Map ID
TAX MAP ID 309.14-1-6:8.2 PE3 1 � 2016 Permit No. 01�rrC( "03 '(P
Permit Fee 5go.lo
LOCATION OF INSTALLATION 17 Ryan Ave. Approvals:
APPLICANT Community Work & Independence, Inc PHONE/E-MAIL 746-2716/ kce@cwinc.org
ADDRESS 50 Pine Street, Hudson Falls, NY 12839
INSTALLFRIQUILDER: TSD PHONE/E-MAIL
ADDRESS:
OWNER Community Work & Independence, Inc PHONE/E-MAIL746-2716/ kce@cwinc.org
Address 50 Pine Street, Hudson Falls, NY 12839
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: Nevin Elms PHONE 746-2716
RESIDENCE INFORMATION SEE PLANS
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed —Y —N
1881-1991 Spa or Hot Tub installed _Y _N
1992-Present
PARCEL INFORMATION SEE PLANS
Topography Flat roiling 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 engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION SEE PLANS
Tank Size gallons (minimum size 9,000 gallons, add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length It.; Each trench _ x
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 know 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: Mark Donahue kDate:
Signature: , Q G L �-0 Date:
J
Town of Queensbury Building & Codes Septic Disposal Permit July 2014
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Transmitted via email
March 20, 2017 E C E O W E
Dave Hatin, Director, Buildings& Codes 2 Z��� D
Town of Queensbury j MAR
742 Bay Road
Queensbury,NY 12804 TOWN! OF QUEENSBURY
BUILDi d 0ES
Re: Wastewater Disposal System
CWI Residence
17 Ryan Avenue
Queensbury,NY 12804
JE 15-005
Dear Dave,
This letter is to certify that representatives from this office visited the CWI residence at
17 Ryan Avenue during construction of the wastewater disposal systems. Based on our
field observations, we feel that the systems have been constructed substantially in
conformance with design plans prepared by this office, entitled "Wastewater
Management, CWI, 17 Ryan Avenue, Queensbury, NY, issued on 1/13/2016, with
construction changes noted on attached Record plans and the following exceptions:
• The northern half of the leach field was moved approximately 6' to the west to
avoid the new sidewalk.
If you have any questions, please do not hesitate to contact us at 792-2907.
Sincerely,
JARRETT Fafflheers, PLLC
3.20
13:07: 3
13:07:03
-04'00'
H.Thomas Jarrett, P.E.
Principal
Encl: 11x17 drawing entitled: Wastewater Management 17 Ryan Ave, Queensbury,NY
Revision 2 dated 8/11/16
Ecopies w/encl: Kevin Elms, CWI Facilities Director
12 East Washington Street 518 792-2907
Glens Falls,NY 12801
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