BOTH-000443-2016 TOWN OF QUEENSBURY
at 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000443-2016 Date Issued: Thursday, July 14, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000443-2016
has been completed.
Tax Map Number: 302.5-1-54
Location: 3 GREENWAY NORTH
Owner: PAUL NICHOLS
Applicant: Dan Hunt
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEENSBBUURY/�
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, GGG V
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.
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TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building & Codes (518) 761-8256
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BUILDING PERMIT
Permit Number: BOTH-000443-2016
Tax Map No: 302.5-1-54
Permission is hereby granted to: Dan Hunt
For property located at: 3 GREENWAY NORTH
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: PAUL NICHOLS Septic Disposal $0.00
Owner Address: 3 Greenway N Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Scott Rowland
Plans& Specifications
Residential Septic Alteration
$ 40.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday,July 7, 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 GeeembuJ Wues ,J 2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL APPLICATION Office Use Only
Received
DATE: _ Tax Map ID
TAx MAP ID: 2�• 5 Permit No. 4 T)+- 44 3-7_0 1
Permit Fee 4 9 a, In . }r7 2—
ZONE: JUL171 1
20
16
APPLICANT Gi PHONE/E-MAIL
ADDRESS
INSTALLER/ PHONE/E-MAIL _
BUILDER �' ✓l C � _3 /('�
OWNER
ADDRESS
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: L c ✓V"C3
PHONE/E-MAIL '� qjD-
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RESIDENCE INFORMATION
Year Built #of bedrooms X gallons per bedroom =total Daily flow
1980 or older Garbage grinder installed —Yes No
1981-1991 Spa or Hot Tub installed Yes No
1992-Present
PARCEL INFORMATION
Topography Flat rolling Steep slope %Slope
Soil Nature and Loarn 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 CONSTRUCTION
Tank size gallons(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 CQ0c ft.;Each Trench
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 the Town of Queensbury Sanitary Sewage Disposal Ordinance.
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PRINT NAME: C DATE.
SIGNATURE: f DATE.
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Town of Queensbury Building&Codes Principal Structure Application Revised September 2014
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