SEP-000569-2017 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-000569-2017 Date Issued: Tuesday, September 19, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000569-2017
has been completed.
Tax Map Number: 309.14-1-64.1
Location: 7 MURRAY AVE
Owner: Neil Dufresne
Applicant: Neil Dufresne
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: SEP-000569-2017
Tax Map No: 309.14-1-64.1
Permission is hereby granted to: Neil Dufresne
For property located at: 7 MURRAY AVE
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
Tyne of Construction
Owner Name: Neil Dufresne Septic Disposal $0.00
Owner Address: 7 Murray AVE Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Straight's Septic Service
72 Sisson RD
South Glens Falls,NY 12803
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,September 12,2018
(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 exp' tion date.)
esbDated at the Town offlues y m er 12,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
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APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT;
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO R
PERMIT. EVIEW BEFORE ISSUANCE OF A VALID
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INSTALLER: ��`'r� � Sk,;;7 r V c ��
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ADDRESS: Z
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LOCATION OF INSTALLATION:
YEAR BUILT OF X COMPUTATION= TOTAL DAILY FLOW RESIDENCE INFORMATION:
BEDROOMS
1980 or older X 150 gallon per bedroom = GARBAGE GRINDER
INSTALLED?
1981 -1991 X 130 gallon per bedroom =
1992-present 3 X 110 gallon per bedroom = SPA OR HOT TUB
31<D INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling ' Steep slope %Slope
✓ SOIL NATURE: Sand 'f Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is
per minute per inch.
(Test to be completed by a licensed professional engineer or architect.)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by
a licensed professional engineer or architect (unless installed in a Planning Board approved subdivision).
TANK SIZE: GALLON (MIN. SIZE IS 1,000 GAL.) Add 250 gallons to the size of the septic tank for
each garbage grinder, spa or whirlpool tub.
SYSTEM TYPE:
ABSORPTION FIELD (WITH NO. 2 STONE) Total length t. Each trench X 5 Cl
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
❑ ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity?
Tank size? Number of tanks?
OTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN '
APPROVED ELECTRICAL INSPECTION AGENCY PLEASE REVIEW LIST PROVIDED.
.............
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any
permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation or
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