SEP-0271-2018 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-0271-2018 Date Issued: Friday, May 18, 2018
This is to certify that work requested to be done as shown by Permit Number SEP-0271-2018
has been completed.
Tax Map Number: 289.8-1-60
Location: 992 BAY RD
Owner: Laurie Kleitgen
Applicant: Plumbing Today
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 4 �ot
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-0271-2018
Tax Map No: 289.8-1-60
Permission is hereby granted to: Plumbing Today
For property located at: 992 BAY RD
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: Laurie Kleitgen Septic Disposal-Residential $0.00
Owner Address: 992 Bay RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plumbing Today
941 Albany Shaker RD
Latham,NY 12110
Plans& Specifications
Residential Septic Alteration
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday, May 17,2019
(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.)
Dated at the Town of bury; �flhu a 7, 2018
SIGNED BY; / for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PER �11 ipefildiv FORelUse Only
742 Bay Road,Queensbury,N 0 _
Fown oftZtcrns ury " #: t!� Z7 1
P: 518--7161--.8256 www. uee etMAY 1 7 2018 '
Tax Map ID#: G'0 m t Fee-. $ 7.5-.20 Invoice#: Cql
-NSB RY
Project Location: �- c. EI I �' $ CODE: Septi Variance? Yes No
Primary Owner(s) a 13 r� 11-`e�-
Mailing Address C Z �
Phone & Email I r 7-3-2 -L1 e6ck
Installer/Builder 7
Mailing Address q4 c' llt�)w Iz y I
Phone & Email c�
Engineer
Mailing Address
Phone & Email
Contact Person for Building&Code Compliance: Phone:
RESIDENCE INFORMATION:
Year Built Gallons #of bedrooms X gallons per =total daily flow
per day bedroom Garbage Grinder Yes No
1950 or older 150 Installed? (circle one)
1951-1991 130 Spa or Hot Tub Yes No
Installed? (circle one)
1992-Present 110
PARCEL INFORMATION:
Topography Flat Rolling Steep Slope %Slope
Soil Nature Sand foam Clay Other
Groundwater At what depth?
Bedrock/Impervious material At what 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 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. ,nn f±-�
PRINT NAME: f+VDATE:
SIGNATURE: i DATE:
Town of Queensbury Building&Code Enforcement Revised March 2018
S1=MIPL T PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
�'IovvN A tms DOCUMENT. I HAVE PERSONALLY
1* 'u,lElII'IAI E SET FORTH ON THIS DIAGRAM,
f lAi ,:E' DATE
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