SEP-000414-2017 TOWN OF QUEENSBURY
u�u 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-000414-2017 Date Issued: Tuesday, September 5, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000414-2017
has been completed.
Tax Map Number: 288.20-1-11.2
Location: 22 NORTHWOOD DR
Owner: Brian Kendrick
Applicant: Brian Kendrick
This structure may be occupied as a: Residential Septic Alteration
(replacing existing field) 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
QL Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000414-2017
Tax Map No: 288.20-1-11.2
Permission is hereby granted to: Bill Camp
For property located at: 22 NORTHWOOD 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
Tvceof Construction
Owner Name: Brian Kendrick Septic Disposal-Residential $0.00
Owner Address: 22 Northwood DR Total Value $0.00
Lake George,NY 12845
Contractor or Builder's Name/Address Electrical Inspection Agency
Bill Camp
69 Taylor Woods RD
Fort Ann,NY 12827
Plans&Specifications
Residential Septic Alteration
(replacing existing field)
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,July 14,2018
(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 expiraattion date.)
Dated at the Town of Q ensbury, [ / daky , 7
SIGNED BY: �_VJ�r-/ for the Town of Queensbury.
Director of Building&Code Enforcement
`rkSB:1l1CD13D0&\LPE MITAPP
�� n 742 Bay Fbad,Queensbury,NY 12804 ; I ' JUL I 1P.518-761-8256 www. ueensbu .n <] �+ Pemlit# 00av67
Tax Map ID# _ ( - TOWN OFQ *W Invoice#.a�D33
Project Location:ol�/.k3 S'pticVariance? Yes No
Primary Owner(s)
Mailing Address O("" c AI l
Phone& Email l
�✓ Installer/Builder
� !C Mailing Address 19,1 iWC04S RA t 1 AuxJ 1, Mcj la 8-2
Phone& Email c1& . a - bcqrn R 69 0-9 G Mm L' �ryn
Engineer yu A
Mailing Address
Phone& Email
Qmtad Person for Building& Oode Complianoe:-Z' . Phone: 5(8 - 36 I -30cj j
RE9 DENCE I NFORM All ON:
Year Built #of bedrooms Xgallons per bedroom =total daily flow Garbage Grinder Yes No
1980 or older Installed? (drdeone)
1981-1991
coor Fat Tub Yes o
1992-Present Installed? (cirdeone)
PARCELINFOFMAMON:
Topography FlatFmlling Seep,9ope _%9ope
Soil Nature Sand _Loam _Oay _Other
Groundwater At what depth?
BedroddImpervious material At what depth?
Domestic Water Supply YMunicipal _Well(if well,water supply from any septicsystem absorption is_ft.)
Percolation Test Hate: per minute per inch(test to be completed by licensed engineer/architect)
PROPOS S'SrEM FORNEW OONSfRUCrION:
Tank sae _gallons(min.sae 1,000 gallons,add 250 gallonsfor each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length ft.; Each Trench ft.
Saepage Fit with#3 stone Flow many: : Sm.
Alternative System Bed or other type:
r� FoldingTankSystem Total required capacity? tanksze #of tanks_
�" NOlES 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 asan as-built plan is received and approved.
The installed system must match the septic layout on file o exceptions
Dedaration:Any permit or approval granted which is based upon or is granted in reliance upon any material
representation or failure to make a material fad or circumstance known by or on behalf of an applicant,shall be void. I
have read the regulatio agree to abide by these and all requirements of the Town of Queensbury Sanitary&-mage
Disposal Ordinance.
PRINTNAME lCi . t[C ( DATE
9GNATU
Town of fury Building&Cbde ErdorcemaA FWsed February 2017
x. ��
288.20-1-11.2 SEP-000414-2017
c7d. Kendrick, Brian
22 Northwood Drive
SEPTIC PLOT PLANN Septic Alt. (replace existing field)
I HAVE SEEN OR OBSERVED ALL OBJECTS J
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC r v'
SHOW -O THIS DOCU'LENT.I HAVE PERSONALLY �..
MEA„qFE D A D STANCE SET FGRTH ON THIS DIAGRAM,
_ LFILE COPY
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