BOTH-000283-2015 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-000283-2015 Date Issued: Tuesday, August 9,2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000283-2015
has been completed.
Tax Map Number: 296.13-1-30
Location: 4 WINCREST DR
Owner: Barbara Warner
Applicant: Jack Hall Plumbing&Heating
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
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
Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000283-2015
Tax Map No: 296.13-1-30
Permission is hereby granted to: Jack Hall Plumbing&Heating
For property located at: 4 WINCREST 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
Tvue of Construction
Owner Name: Barbara Warner Septic Disposal $0.00
Owner Address: 4 WINCRESTDR Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Jack Hall Plumbing&Heating
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,November 6,2016
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of QueWb -
ira/i�Jpn dat )
Dated at the Town4 T November 12,2015
SIGNED BY: V for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL APPLICATION Office use Only
Received 11h,51a 0/
DATE: ' 1 / [ �J Tax Map ID 06.
TAX MAP ID: 93-olS Permit No. KOC O�U2 �2D 15
ZONE: p�J Permit Fee
ro APPLICANT ffik'6?q& "R pIej� PHONE/E-MAIL
SZ/
ADDRESS t✓y CAEJ�f fflP Jf(j" 'ity, laeo
INSTALLER/ PHONE/E-MAIL
BUILDER JOU`-
OWNER Ty I
ADDRESS (b� ( � SFS 6l�a'f �a4lrs Pl,,fr 1a8o (
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: _ TY 4 A-
PHONE/E-MAIL ✓18�36 � '- J7�y�
RESIDENCE INFORMATION
Year Built #of bedrooms X gallons per bedroom =total Daily flow
1980 or older 3 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 Sand Loam Clay _Other
Groundwater At what depth:
Bedrock/Impervious material At what depth:
Domestic Water Supply —4 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 LAWL 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 Q ft.;Each Trench�LJE
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 o behalf of an applicant,shall be void.I have read the regulations and agree to
abide by these and all req%uirle�/ ents of the Town oI -eensbury Sanitary Sewage Disposal Ordinance
PRINT NAME: / < /� / DATE:
SIGNATURE: DATE:
Town of Queensbury Building&Codes Principal Structure Application Revised September 2014
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15 2015
TOWN OF QUEENSBURY
BUILDING & CODES
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II REFERENCE:
Phillip K.Whittamore,as Trustee of THEsituated in
EVELYN M.ROBINSON,rRUST u/a
Town I QueensbC
ury
toOUrlty New 'York
James A.and Barbara H,Warner
D:
Decenber 2000 1198/281 Scale: 1 30' May 10, 2001
Survey and ilvlap by
CHARLES T. NACY
NIAP REFERENCE:'
Licensed Land surveyor
"Revised Ma p of Part of the la ids of 32 John Street
Edwin R.Wini known as Maple - Queensbury, NY 12b04
Heights,"dated 3/23/1954,revised Illy
4[,2711954,made by A.j.'Larif ar,L.S.,
filed in the Warren Co.Clerk'q Office
on 5/4/1954 in QueensoutY Mop EA.4,
Page 17. !JwILAhorized alter tion or addition to a
SLU'vey, map bearing as licensod land
SUIrveyor's seal is a violation of Secdo'n
7209, ,iib. ,divisiori 2, of the Nevis York Stat,,:
Educaflon Lavj.
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