2011-393 TOWN OF .QUEENSBURY
742 Ba Ytoad ueensb NY 12804-5902 518 761-8201
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Community Development=Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: . P20110393- Date Issued: Tuesday, August 09, 2011
This is to certify that work requested to be done as shown by Permit Number P20110393
has been completed.
Tax Map Number: 523400-227-017-0001-024-000-0000.
Location: 8 .N. SEELYE Rd
Owner: MATTHEW& GERALDINE EBERLEIN
Applicant: MATTHEW& GERALDINE EBERLEIN
This structure may be occupied as a:
Test Pit/Perc Test Review
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, '' /V/ ,/-46"---1
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
11%
`im 742 Bay Road,Queensbury,NY 128045902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20110393 Application Number: A20110393
Tax Map No: 523400-227=017-0001-024-000-0000
Permission is hereby granted to: MATTHEW&GERALDINE EBERLEIN
For property located at 8 N SEELYE 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 Value
Owner Address: " MATTHEW.&GERALDINE EBERL
42 N RUGGLES Rd Test Pit/Perc Test Review
SARATOGA SPRINGS,NY 12866 Total value
-C
Contractor or Builder's Name]Address Electrical Inspection Agency
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Plans&Specifications
2011-393
deep hole/perc test
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$200.00 'PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday;August 09,2017'
(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 wn Quee bu" T sd ,August 09,2011
SIGNED BY - for the Town of Queensbtny.
Director of Building&Code Enforcement
� Town of Queensbury■ Building&Codes Enforcement Office■742 Bay Road• Queensbury,NY 12804
DEEP HOLE/PERC TEST
Request for Town Engineer Review
Property Owner: frk-r E -L-euN Phone: 4i — 3%Z left,
Property Owner's
Address: 0 5LY(. ,Ej ! (qa E ��ru
Location of Test: '#8 '/02 Tax ID#: 2 Z7. I1 —) — 2.4125
*Applicant's Engineer: 2 PE Phone: 6347 —6699
Applicant's Agent: (1 .11��t�l (z-ltJ P t..e— Phone:
Additional Notes:
1.Reason for Request? n New Septic System 102 Replacement Septic System Failed Septic System
Subdivision n Site Plan Review
2.Are Wetlands present? YES X NO UNKNOWN
*Note: Applicant is required to engage an engineer for design and testing of the h te.EhELEovnw, E
Engineer's responsibility is to witness system testing only.
PLOT PLAN: Plot plan, to scale, to be submitted with application AUG 0412011
FEE SC @ _ TOWN OF QUEENSBURY
a. $200 Flat Fee Date Paid: f— UILDING & CODES
Check No.:
b. OR Fee to be determined during To Be Determined:
Site Plan/Subdivision review process
SIGNATURE:
In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may
engage the services of a qualified professional consultant for expert review and recommendation arising
from the carrying out of the provisions of Art. IV, including but not limited to the review of plans,
specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep
hole and percolation tests, system installations, and any other aspect of any matter contained in this Art.
IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before •
any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an
invoice for same, whichever is sooner. Such costs shall not exceed $1,500 without prior written notice to
the party to be charged with same.
My signature below indicates I have thoroughly read and understand the instructions, agree to the
submission requirements and have completed the application. I also fully understand that additional
engineering fees may be necessary per Town of Queensbury Local Law 136-14D.
SIGNATURE OF APPLICANT: IC5:11 ;LCe-7Date: 5 4' j(
SIGNATURE OF AGENT: Date:
Original (B&C File) Canary(Planning) Pink(Applicant) Gold (Town Clerk)
Aug 0811 02:28p - RIPER 5185813893 p.2
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RK Engineering, PLLC '
225 Ruggles Road . House,,
Saratoga Springs, NY 12866 . /o `�r .'
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--REAIIMENT FlELD'TIE-IN DIMENSIONS (FT)
STRUCTURE. CORNER
A -C D.-
PROPOSED SEPTIC SYSTEM TREATMENT LA
PLOT PLAN INFORMATION OBTAINED FROM OMER
- - - PROVIDED SITE PLAN AND SCHENECTADY COUNTY GIST
THIS DRAVANG DOES NOT REPRESENT A LAND SURVEY
AND MUST NOT BE CONSTRUED AS.SUCH.