SEP-000203-2017 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-000203-2017 Date Issued: Friday, May 5, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000203-2017
has been completed.
Tax Map Number: 308.6-1-55
Location: 23 WARREN LN
Owner: Ronald Morehouse
Applicant: Fred Smith
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEENSSBURY Issuance of this Certificate of Compliance DOES NOT relieve the ( I f/ �,J/� 44t
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.
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-000203-2017
Tax Map No: 308.6-1-55
Permission is hereby granted to: Fred Smith
For property located at: 23 WARREN LN
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: Ronald Morehouse Septic Disposal-Residential $0.00
Owner Address: 1530 Route 9N Total Value $0.00
Saratoga Springs,NY 12866
Contractor or Builders Name/Address Electrical Inspection Agency
Frederick Smith
23 Vermont AVE
Queensbury,NY 12804
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,May 2,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the ex ationn dateWy
Dated at the Town of ueensb //foes7
SIGNED BY: /(� for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only
4742 Bay Road,Queensbury,NY 12804 L'�i�
T.aF P:518-761-8256 www.aueensbury.net Permit#: . -_ .AQ3'a-d17
Tax Map ID#: 368, -1�J Permit Fee:$ �Invoice#: 17' '
Project Location septic variance? Yes No
Primary Owner(s)
Mailing Address -Cmq 15-30 &L,{z 4)a Hyl„ I�fr66
Phone&Email r-r7
Installer/Builder
Mailing Address D
Phone& Email 3D
Engineer NO
Mailing Address T wN OF QUEENSBUR
Phone& Email COMMUNITY DEVELOP NT
Contact Person for Building&Code Compliance: Phone: li/Z/ L4 9':�-6
RESIDENCE INFORMATION:
Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes
1980 or older Installed? (circle one) V
Spa or Hot Tub Yes Np/
1981-1991 Installed? (circle one)
1992-Present
PARCEL INFORMATION:
Topography V Flat Rolling _Steep Slope _%Slope
Soil Nature _Sand _Loam _Clay _Other
Groundwater At what depth?
Bedrock/Impervious material At w at depth?
Domestic Water Supply unicipal _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 for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length ft.; Each Trench ft.
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. Ll
PRI NTNAM E:� DATE:
SIGNATURE: DATE:
DATE:
Town of Queensbury Building&Code Enforcement Revised February 2017
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