BOTH-000373-2016 f, 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-000373-2016 Date Issued: Friday, June 23, 2017
This is to certify that work requested to be done as shown by Permit Number BOTH-000373-2016
has been completed.
Tax Map Number: 239.12-2-32
Location: 99 ASSEMBLY POINT RD
Owner: MICHAEL CHRYS
Applicant: MICHAEL CHRYS
This structure may be occupied as a: Residential Septic Alteration
Revised plans received 6/23/2016 By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the 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
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: BOTH-000373-2016
Tax Map No: 239.12-2-32
Permission is hereby granted to: Crandall Excavating
For property located at: 99 ASSEMBLY POINT 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: MICHAEL CHRYS Septic Disposal $0.00
Owner Address: 99 Assembly Pt. RD Total Value $0.00
Lake George,NY 12804
Contractor or Builder's Name!Address Electrical Inspection Agency
Crandall Excavating
63 WOODCHUCK HILL RD
Lake George,NY 12845
Plans&Specifications
Residential Septic Alteration
$ 40.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,June 15, 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 Town sbury; M a 0, 2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT
Office Use Only
DATE — ((p— E Received
Tax Map ID
TAX MAP ID Permit No. Fy� -2-,i k
Permit Fee 1 +6
LocATlON OFIIUSTALLATION ' A� L`C �,� Approvals:
APPLlcANT (G AEL- PHONE/E-MAIL -359 - 5559
MAt,u1� A-D7)
�
ADDRE=SS � - - `�'El�l�iL—''l' ''t�"�+►1rtT INSTALLER/BUILDER--PHONE/E-MAIL * —d>&Ln�I
ADDRESS:
0WNERC. PHONE/E--MAIL
Address
ON CT PER N BUlLD1N A ODE OM LIAN E: PHONE
RESIDENCE INFORMATI NJUN
� j _L 7
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed s Y ✓N
1981-1991 Spa or Hot Tub installed _Y _N
1992-Present
PARCEL INFORMATION
Topography Fiat rolling Steep slope %slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth
Bedrock/Impervious Material At what depth? �"
Domestic Water Supply Municipal '7' Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: it- per minute per inch (test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size 1 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 ft.; Each trench X
Seepage Pit with#3 stone How many., ;size
Alternative System Bed or other type? CMPF 5eb LS 5 —5ZL-F
Holding Tank System uired capacity? Tank size #of tanks
Ta .r5t.C��Total
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.
DECLARA77 N. 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 agree to a 'de by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: Date: 1E �(Q
Signature: Date:
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