SEP-000822-2016 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: SEP-000822-2016 Date Issued: Friday, December 2, 2016
This is to certify that work requested to be done as shown by Permit Number SEP-000822-2016
has been completed.
Tax Map Number: 309.10-1-55
Location: 65 1/2 Main ST
Owner: Donna Hoskins
Applicant: Donna Hoskins
This structure may be occupied as a: Septic Alteration
By Order of Town Board
TOWN OF QUEENS,BtURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, /d
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.
/r~ TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000822-2016
Tax Map No: 309.10-1-55
Permission is hereby granted to: Donna Hoskins
For property located at: 65 1/2 Main ST
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
Tvce of Construction
Owner Name: Donna Hoskins Septic Disposal-Residential $0.00
Owner Address: 1636 RIDGE RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Rick McGuire
Plans&Specifications
Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,December 1,2017
(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 Queensbury; Thursday,December 1,2016
SIGNED BY: for the Town of Queensbury.
Direct w mg&Code EJcemen
SEPTIC DISPOSAL PERMIT Office Use Only
DATE nn U V e ved
ap ID
Z2—ZC)
TAX Mar ID it No. �
/ ( C 1 2T!3 it Fee
LOCATION OF INSTALLATION "r �� App vals:
L G 8 GOES Y
APPLICANT PHONE/E-MAIL
ADDRESS
INSTALLER/BUILDER. PHONE/E-MAIL
ADDRESS: l I' L
OWNER DOna0- goskins PHONE/E-MAIL ^ ,
Address (4 (o Til CL42 AJ Gur24 A SbL ry rV
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: e%oL rib V..\ PHONE1--1 to�M Zlp
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed Y _N
1981-1991 Spa or Hot Tub installed _Y _N
1992-Present
PARCEL INFORMATION
Topography V Flat rolling Steep slope _%slope
Soil Nature -jG 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
Percolation Test Rate: per minute per inch(test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size 1600 gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length ft.; 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 th se and all requirements of the Town f Queensbury Sanitary Sewage Dispo,al rdinance.
Print Name: r cr< /t I c Gvu Q!dc ✓cam �(� Date:
Signature: Date:
Town of Queensbury Building&Codes Septic Disposal Permit July 2014