BOTH-000242-2016 TOWN OF QUEENSBURY
'iF;.;�.•�'' „troy 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000242-2016 Date Issued: Thursday, June 9, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000242-2016
has been completed.
Tax Map Number: 309.15-1-44.1
Location: 218 FIFTH ST
Owner: Lin Lizhong
Applicant: Sanitary Sewer Service
This structure may be occupied as a: Septic System Alteration
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the r J
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
747 Bay load,Queensbury,NY 12804-5944 (518)761-8241
Community Development - Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: BOTH-000242-2016
Tax Map No: 349.15-1444,1
Permission is hereby granted to: Sanitary Sewer Service
For property located at: 218 FIFTH 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: Lin Lizhong Septic Disposal $0.04
(.owner Address: 218 Fifth Street EXT Total Value $0.44
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Sanitary Sewer Service
PO Box 224
Glens Falls,NY 12801
Plans&Specifications
Septic System Alteration
$ 44.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Monday, April 24, 2017
(ifa 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 cafz
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SIGNED BY: a for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT Qffica tJse C1*
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Year Built #of bedrooms X Gallons per bedroom -Total Bally Flow
1080 or older Garbage grinder installed _Y VN
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//0 C Spa or Hot Tub installed Y
7992-PrBsant
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Topography Flat rolling Steep slope %slope
Soil Nature Sand loam Clay Other
Groundwater At What depth?
Bedrock!Impervious Material At what depth?
Domestic Water Supply Municlpal Well(dwell,water supply from any septic systems absorption is ft.)
Percolation Test Rate: -J per minute per inch(dust to be completed by licensed engineering C archiited)
1214OposEA3 SMM CJt AWErJ 7 8►C770M
Tank Size L". 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 "Notal length °.. ' ` ft.,Each trench -
Seepage Pit with#3 stone How many. size
Alternative System tied err other type's
Holding Tank Systems Total requmed capacity? Tank size #of tanks
Notes, 1)Mama systema&associated electrical work must be inspected by a Town approved electrical inspection agency,2)we will no longer
atiouw systems to be covered until such time as an As-Bullt plan is received&approved. The Installed system roust match the septic systema
layout on Trie—no exceptions_
DEcr.ARA771?rtF. Any permit or approval granted which is based upon or is granted in reliance upon any material representation or
failure to snake a material fact or circumstance know by or on behalf of an applicant, shall be void. l have read the regulations
and agree to abide these and all r ulrem of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: � - � Clete: -� ;7�`��
Signature:
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Town of Queensbury Building&Codes Septic Disposal Permit Jpal'y 2014
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