BOTH-000193-2016 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: BOTH-000193-2016 Date Issued: Friday, April 29, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000193-2016
has been completed.
Tax Map Number: 295.14-2-34
Location: 10 JOHN CLENDON RD
Owner: KRYSTLE SWEESTER
Applicant: Stone Installations
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.
I-OWN OF QUEENSBURY
742 Flay Road,Queensbury,NY '12804-5904 (518)761-8201
V� r
l
Comm unity Development- Building�Codes (5'l8) 761-82.56
B UILD I.N G PERM I T
Permit Number: ff3(:),rH-000193-2016
Tax Map No: 295.14-2-34
Permission is hereby granted to: Stone Installations
For property located at: 10 J01 IN C1,1 NDON 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: K.RYSTL E SVv[.I;Suiz Septic Disposal WOO
Owner Address: 10 John Clendon RD 'total Value WOO
Queensbury,NY 128024
Contractor or Builder's Name/Address Electrical Inspection Agency,
Stone Installations
4205 Route 50
Saratoga Springs,NY 12,866
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FfT PAID-T]VIS PERMIT FIX P]RES: Thursday,April 6,2017
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
ofthe Town of Queensbury before the expiration date.)
Fated at the Town of"7aIry, Mo st y, pril I'1,2016
SIGN[-.'.D BY: for the TOWn ofQuecnsbury.
Director of Building&Code I'ralirrcemcnt
SEPTIC DISPOSAL APPLICATION Office Use Only
Received
DA"IT: ' " 44 Tax Map IIS
Permit No. �A - l 0 'Ci.3. A
TAX MAP ID: � .. "A �1 M � Permit Fee
ZONE:
.APPLICANT � �� a � � m , p �'s� � PHONE/E-MAIL W),, „
ADDRESSr
I'NSIAT.T,T!,Tt/ � �. � PTIoNT /T" MAIL
13UIT.,DER `� � � � y',° .„ ()
m„
OWNER
Tt
ADDRESS `rc
r' 6/e 1 .1w ,
CONTACTPERSON FOR BUILDING&.CODE COMPLIANCE:
PHONE/E-MAIL � ° � �� ,..�
RESIDENCE INFORMIATION
Year Built fi of bedrooms X gallons per bedroom total Daily flow
1980 or older Garbage grinder installed Yes kip"
1981-1991 Spa or Hot Tub installed Yes Zd
1992-Present i )
PARCEL INFORMATION
Topography Flat rolling Steep slope %Slope
Soil Nature � Sand Loans Clay Other
Groundwater At what depth—
Bedrock/Impervious material At what depth,
Domestic Water Supply ... unicipal __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)
I ItOPOETd SYSTEM FOTO NEW CONSTRUCTION 7�~ L-DnatC
Tank size 'dI i galloons(min.size 1,000 gallons,add 250 gallons to size for cacti garbage cylinder or spa or hot tub
System Absorption field with 42 stone 'Total length " ft.;Each"Trench
Seepage Tait with#3 stone Flow many. ;air
Alternative System Bed or other type:
Holding Tank System "Total required capacity? _�-.- 'I°ank size 9 of tanks
Nates: 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&approved. The installed system must match tine
septic system 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 oroumstance known by or on behalf of an applicant,shall be void. 1 have read the regulations and agree to
abide by these and al l realu nts of tlicVo n of Qupcnsbury Sanitary Sewage Disposal Ordinance.
PRINT NAME: � 1 t"�.� DATE:
SIGNATURE: DATE.
Town.of Queensbury Buildin &Coded' Principal Structure Application Revised September 2014
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