SEP-000761-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
6L Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-000761-2016 Date Issued: Monday,November 7, 2016
This is to certify that work requested to be done as shown by Permit Number SEP-000761-2016
has been completed.
Tax Map Number: 296.14-1-38
Location: 8 EDGEWOOD DR
Owner: Trung Nguyen
Applicant: The Country Plumber
This structure may be occupied as a: Residential Septic Alteration
Replacing incoming line and sewer tank only By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the r j
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 OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
s Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000761-2016
Tax Map No: 296.14-1-38
Permission is hereby granted to: The Country Plumber
For property located at: 8 EDGEWOOD DR
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: Trung Nguyen Septic Disposal-Residential $0.00
Owner Address: 8 EDGEWOOD DR Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
The Country Plumber
23 LEO ST
Queensbury,NY 12804
Plans&Specifications
Residential Septic Alteration
Replacing incoming line and sewer tank only
$40.00 PERMIT FEE PAID-TIES PERMIT EXPIRES: Thursday,November 2,2017
(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 exp/�'[�ation
e date.)
Dated at the Town of ueensb E/ ted s a er 2,2016
SIGNED BY: �/ /d k for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT Office Use Only
DATE Il�y��n `� Received
Tax Map ID
Tax MAP ID Permit No. '515—P- 11ZI• Zo Ilp
r j,, Permit Fee 'l,X10
LOCATION OF INSTALLATION cUG'C-�V OC�C� by 1 V'J�-' Appwvals- lY1VII w- 122-2-
APPLICANT
LZLAPPLICANT 1 PHONE/E-MAIL
ADDRESS DYrV-,c, `)
1ZO4
INSTALLEROUILDER: 6��. "i�(�
/ IaZ6 'C-6 PHOJNE/E-MAIL /7�� i� 2 se:t �
ADDRESS: ^_6��/{ /� c�flt✓'�� � h0 9L fL/ � 7o'/�5t
OWNER I�- PHONE/E�-MAIL
Address 8 v--r oclr v N 12-b(04
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: O/��l�L� fGJi3;.t PHONE 3i8��23
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older ar n e ' t Y _N
1981-1991 a r IN Y _N
1992-Present
PARCEL INFORMATION
Topography _Flat rolling _Steep slope _04 slo-a®WN OF QUEENSBURY
Soil Nature Sand _Loam
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
Percolation Test Rate: per minute per inch(test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size ` gallons(minimum size 1,600 gallonlad 250 gallons to size for ea rbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length 2ASP, ft.; Each trench x '1
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 th and all requir n s pf t Town of Queensbury Sanitary Sewage Disposal rdinance.
Print Name: Y Date:
Signature: Date: '///¢auto
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
SY.S--Em
PgZ� Fo fZ.v1V �b14
Fa.Y.I
to
�vGt: vilao� l�iP� �r I
ti
CD
Q cu
CL
�Csie�n 6aScdO✓� �-�cdfdo,,.,s -1-obc Pun.Pedd-�,I�cd w �r- nG�, 6� �--- SG � Q
N U
P �a0Pa . >
00 0 -
m 0
bncar �r• d N a�'i ami
w Zo a�
N z 00
*Al07- To sGl4LC �R�✓,c►✓ 3
,vo —1-r-aw da B�cc
OF SNsrrw► 7d SILDING
E � MC�
ISSg�avN�>~ TOWN OF�UEEiN;BIU7
rJE,� FR�+Lo /off cxi ab�� y; " U , TI01 2016lXYO 941• Poor ,� BUILDIN ,
SEPi�C Ti4�1K IEWED B TUEENS y
SEPTIC PLOT PLAN lc z4V POR' 31n)p mS d
a ��_ I.
HAVE SEEN OR OBSERVED ALL OBJECTS 6 �14��pp�j. I S PT.
SUCH AS HOUSES, T EES, FENCES, ETC ydr`IcTQ�7e e �9 � �y>��s
SHO TU
N THI}�D HAV PERSONALLY f�
M EDTHE D( H THISDI
eVp44 Tire c�Rl Fr I
; � � i � IIII ! iJII � I I Ii
�� t _C.�ej
- 3