SEP-0314-2018 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-0314-2018 Date Issued: Friday, June 15, 2018
This is to certify that work requested to be done as shown by Permit Number SEP-0314-2018
has been completed.
Tax Map Number: 301.14-1-37
Location: 45 PEGGY ANN RD
Owner: Joshua McCullen
Applicant: Sanitary Sewer Service
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, 4 4t
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-0314-2018
Tax Map No: 301.14-1-37
Permission is hereby granted to: Sanitary Sewer Service
For property located at: 45 PEGGY ANN 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: Joshua McCullen Septic Disposal-Residential $0.00
Owner Address: 45 Peggy Ann RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Sanitary Sewer Service
PO Box 224
Glens Falls,NY 12801
Plans&Specifications
Residential Septic Alteration
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday, June 5,2019
(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; ues , J ne 5, 2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT A —.".Office Use Oniv
742 BaV Road,Queensbury,Ny,412_80� 1 14
Project Location:-
Phone & Email 1110 K2
Installer/Builder J4-/L"
Engineer
Mailing Address
Phone & Email
Contact Person for Building&Code Compliance: ��Ora__(2 Phone: 7 t 212�K -To Wo
RESIDENCE INFORMATION:
Year Built #of bedrooms X gallons per bedroom total daily flow Garbage Grinder Yes N
1980 or older Installed? (circle one) �Z_
1981-1991 -3 Spa or Hot Tub Yes _NW_
1992-Present I Installed? (circle one)
PARCEL INFORMATION:
Topography Flat Rolling Steep Slope %Slope
Soil Nature X Sand Loam Clay Other
Groundwater At what depth? /L,- A
Bed rock/I m pervious material At what depth? /V f'l
Domestic Water Supply _2�Municipal _Well(if well,water supply from any septic system absorption is_ft.)
Percolation Test Rate:J_:1�S per minute per inch(test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size /=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 length Z-0c) ft.; Each Trench -S-X) —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.VVe will no longer allow systems tobe covered until such time asan 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: DATE:
SIGNATURE: DATE:
Town mcueen,uun/Building&Code Enforcement Revised February zuo