BOTH-000234-2016 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-000234-2016 Date Issued: Thursday, April 28, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000234-2016
has been completed.
Tax Map Number: 295.18-2-16
Location: 8 CROWNWOOD LN
Owner: ROMAN JAROSH
Applicant: ROMAN JAROSH
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.
TOWN OF QUEENSBURY
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742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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Comn-ittnity Development - Building Codes (518) 761-8256
BUILDING PERMIT
Permit Number: BOTI-I-000234-201
Tarr Map No: 295.18-2-16
Permission is hereby granted to: Stone Installations
For property located at: 8 CROWNW OOD LN
In the Town of Queensbury,to construct or place at the above location in accordance with application together
with plot plans and other infonnation hereto riled and approved and in compliance with the NYS Uniform.
Building Codes and the Queensbury Zoning Ordinance
Type of Construction
Owner Name: ROMAN,IAROSH Septic Disposal $0.00
Owner Address: 8 Crownwood LN Total Value $0.00
Queensbury,NY 1.2804
Contractor or Builder's Name/Address Electrical Inspection Agency
Stone Installations
4305 Route 50
Saratoga Springs,NY 12866
Flans&Specifications
Residential.Septic Alteration
$ 40.00 PERMIT FEE PAID -'rms PERMITEXPIRES: Friday,April 21, '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 To ttcensbu s it 26, 2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Cade Enforcement
SEPTIC DISPOSAL PERMIT Office Use QUI
DATE Received
TAx MAP ID 6-,120 116),6) Tax Map ID
zk�)-14 Permit No. -U'nA-- 2, 7-0 1 \c,
Permit Fee w C"t. 510
LocATIONOFINST
ALLATIO Approvals:
APPLICANT
PHoNEIE-mAIL
ADDRESS 'S' cltoallolltxoe')o �/z
INSTALLERIBux PHONEIE MAIL
S
ADDRESS:
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v-)4z6. PHONE IE-mAll,
Address
CONTACT PERSQN FOR SUILOM&CQ120 QW41AN i4oNt
REsiDENcE INFORMA 110
Year Built #of bedrooms X Gallons per bedroom Total Daily Flow
r� Z'
1980 or older 15- Z7Y 4N
1981-1991 or HVTub installed" 1Y1 N
T,
1992-Present
PARCEL INFORMA T10 To
)F p�j
Q' z
6 �":"K",§,", U
Topography
-,L--Flat rolling —Steep slope .....
Soil Nature _Z Sand —Loam Clay Other
Groundwater At what depth?
Bedrock/Impervious Material At what depth?
Domestic Water Supply X"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 engineering/architect)
PRoposm SysTEm Fog NEw CoNsTgucvo Nec-, ZILA C�A2NB?Ek6
Tank Size gallons (minimum size 1:,000 gallons, add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length___A_ct&LL_ft.;Each trench----&-QL—x
Seepage Pit with#3 stone How many: ,size
ry
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 & approved. The installed system must match the 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 or circumstance know by or on behalf of an applicant, shall be void. I have read the regulations
and gree to abide by se and all re rements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: Date:
Signature: Date:
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Town of Queensbury Building& Codes Septic Disposal Permit July 2014
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