SEP-000079-2017 / 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-000079-2017 Date Issued: Wednesday, March 8, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000079-2017
has been completed.
Tax Map Number: 295.19-1-35
Location: 24 LYNNFIELD DR
Owner: Brian Evanson
Applicant: Morning Star Septic
This structure may be occupied as a: Residential Septic Alt.
By Order of Town Board
TOWN OF
OWNOF QUEENSSBBURY
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: SEP-000079-2017
Tax Map No: 295.19-1-35
Permission is hereby granted to: Brian Evanson
For property located at: 24 LYNNFIELD 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
Tvce of Construction
Owner Name: Brian Evanson Septic Disposal-Residential $0.00
Owner Address: 24 Lynnfield DR Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Morning Star Septic
107 Jewell RD
Gansevoort,NY 12831
Plans&Specifications
Residential Septic Alt.
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,March 7,2018
(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.)Oy,
Datedat the Town of ueensb /�'uesMt, 017
SIGNED BY: /vJ or the Town of Queensbury.
Director of Building&Code Enforcement
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SEPTIC DISPOSAL PERM T PLICATION Jse Only
_
742 Bay Road,Queensbury,NY 11 4 MAR 0 3 2017 _ ��7y -w1
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Tax Map ID#: a f ��— ��— �� COMMUNITY C VELO MEYM Fee:$2/0, (4 Invoice#:
Project Location: �h`1"�CI � �T� Septic Variance? Yes No
Primary Owner(s)
Mailing Address t(
Phone & Email
Installer/Builder 7—
MailingAddress
Phone & Email p
Engineer --
Mailing Address
Phone & Email
Contact Person for Building&Code Compliance: Phone: q Li go k
RESIDENCE INFORMATION:
Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes No
1980 or older Installed? (circle one)
1981-1991 Spa or Hot Tub Yes No
Installed? (circle one)
1992-Present
PARCEL INFORMATION:
Topography la Rolling _Steep Slope _%Slope
Soil Nature Sand _Loam _Clay _Other
Groundwater At what depth?
Bedrock/Impervious material At hat 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 I/1�gallons(min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total lengt ft.; Each Trench L( S ft. f
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 and approved.
The installed system must match the septic 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 of the Town of Queensbury Sanitary Sewage
Disposal Ordinance.
PRINT NAME: 0' ..v S DATE: ;
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SIGNATURE: DATE:
Town of Queensbury Building&Code Enforcement Revised February 2017
518.793-2290
Fax#518-793-2115
No 597 E-mail: morningstarseptic@hotmail.com
www.morningstarseptic.com
7PTIC SERVICE
Date: C" `� — a`�� 107 Jewel Road,Gansevoort, NY 12831
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I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
SHOWN ON THIS DOCUMENT I HAVE PERSONALLY
MEASURED THE DISTANCE SET 2TH ON THIS DIAGRAM.
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SIGNATURE DATE
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295.19-1-35 SEP-000079-2017 �'
i 3 2017
Brian Evanson MAR��
24 Lynnfield Drive ` ENSBURY
Residential Septic Alt. `{ `JELOPMENT
518-793-2290
Fax#518-793-2115
N� 335 E-mail: morningstarseptic@hotmail.com
www.morningstarseptic.com
DTIC SURVICE
Date: �.� 1 7 107 Jewel Road,Gansevoort, NY 12831
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