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SEP-0716-2018 �fi TOWN OF QUEENSBURY t 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 • �Y A Community Development- Building& Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: SEP-0716-2018 Date Issued: Wednesday, November 21, 2018 This is to certify that work requested to be done as shown by Permit Number SEP-0716-2018 has been completed. Tax Map Number: 309.11-1-50 Location: 27 GARNER ST Owner: Donald Black Applicant: Straight's Septic 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, �d 4/0't 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-0716-2018 Tax Map No: 309.11-1-50 Permission is hereby granted to: Donald Black For property located at: 27 GARNER ST 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: Donald Black Septic Disposal-Residential $0.00 Owner Address: 27 Gamer ST 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 $ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,November 14,2019 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensb before the xpiration dat,.) Dated at the Town o Quee �Ve. .•;�/ lovember 14,2018 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement SEPTIC DISPOSAL PERMIT AP f 14e Dniy � 742 Bay Road,Queensbury,NY 12t&JC r Wig ' nrn of(1-! .,ntz:�- P:518-761-8256. Kern-it it (ft 1(1 `Z6( �c•,, z� r ;: u ��,_.. Tax Map ID#: 3 D di . I I- ( S NOV 1 3 20irrr itge $ 7 J, Invoice#: /U 36 Project Location: 21 - SQWN OF QUEENSIOU*riaAce? Yes No BUILDING&CUUtS Primary Owner(s) Mailing Address 1"e2 Mc" 1-1sbor,.,1 IJy I a1`d 014 Phone & Email Installer/Builder � 14s ` Ser—Q Mailing Address r S'iSScD ry ( Sd (F,n S A 5 N ( Phone & Email (5 ) 1- C -- k-.I.gg 3 Engineer Mailing Address Phone & Email Contact Person for Building&Code Compliance: 5s--k Phone:S I�j 1 e `-J 9,73 RESIDENCE INFORMATION: Year Built Gallons #of bedrooms X gallons per =total daily flow per day bedroom Garbage Grinder Yes No 1980 or older 150 Installed? (circle one) 1981-1991 130 Spa or Hot Tub Yes No Installed? (circle one) 1992-Present 110 \ \ PARCEL INFORMATION: Topography V Flat Rolling Steep Slope %Slope Soil Nature V Sand Loam 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 ic5czgallons(min.size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub System Absorption field with#2 stone Total length iL.e,D ft.; Each Trench (c,CD ft. Seepage Pit with#3 stone How many:_ Z, ;Size: I. <- 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. PRINT NAME: CSLo. 1\ rr�)dC — DATE://- li3° o " SIGNATURE: -�''�— DATE://_ /33-'7(Dl Town of Queensbury Building&Code Enforcement Revised March 2018 cc-5 m' = C-t'l icPrl A maimn10 C) v Oci n c 2 o PLOT PLAN c ' ll- r m zcj 0 C m cn 7 r Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all rov it s. Cr n ill CWO -0 C� At r%-- SIDE PROPERTY LINE rn z 0 5 - cn r- 0 C � I� < o G /1 N') - T- z rn i n -1 . rn D D Teui n T i`� T rn F- z ) 0 06 - -CP - -, _.� �—,i ��On Lli � V - ; Z ,.' 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