SEP-000777-2016 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: SEP-000777-2016 Date Issued: Wednesday,November 16, 2016
This is to certify that work requested to be done as shown by Permit Number SEP-000777-2016
has been completed.
Tax Map Number: 279.19-1-8
Location: 55 JENKINSVILLE RD
Owner: Jack Straight
Applicant: Mike Regan
This structure may be occupied as a: Residential Septic Alteration
Replacing metal tank wiht contrete tank 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
QL
1
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000777-2016
Tax Map No: 279.19-1-8
Permission is hereby granted to: Straight's Septic Service
For property located at: 55 JENKINSVILLE 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
Tvce of Construction
Owner Name: Jack Straight Septic Disposal-Residential $0.00
Owner Address: 55 Jenkinsville RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builders Name/Address Electrical Inspection Agency
Straight's Septic Service
1 Myron AVE
South Glens Falls,NY 12803
Plans&Specifications
Residential Septic Alteration
Replacing metal tank wiht contrete tank
$40.00 PERMIT FEE PAID-TMS PERMIT EXPIRES: Thursday,November 9,2017
(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 aj4W
xj t.rationn date.)
Dated at the Town o Queensb e vember 9,2016
SIGNED BY: date.)
the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT Office Use Only
DATE J I- 1? 1 , Received
Tau Map ID _ /,,
TAX MAP ID Z, l (�r�i::. y�lfl'!,xf`tol 1 t- �j K+
C r ' - - ermif �✓a i I %
LOCATION OF INSTALLATION SS 3-Cti I U Al rov I p
NOV (i y 20' i
APPLICANT I GAN T11�"4Y� �,")�"--<`- , 3}i, .' 4i PNE/ MAIL
ADDRESS tb L L 0 ttr
INSTALLER/BUILDER: G ACY 61e— je f— PHONE/E-MAIL
ADDRESS: �.
OWNER IC yl I I V I I/�'11 r"7 PHONE/E-MAIL
Addressy15 �'tn
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: PHONE
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or o"'e ' Z Garbage grinder installed _Y _N
1981.1991 Spa or Hot Tub installed _Y _N
1992-Present
PARCEL INFORMATION
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 _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)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size A 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?
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
agree to abide by these and aII re uiremer�s of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: /�1 I C(¢Yt�L (GG-(>q A3 Date:
Signature: 1146 Date: '
Town of Queensbury Building&Codes Septic Disposal Permif July 2014
FILE Cpp
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s€PTIC PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS `
SUCH AS HOUSES, WELLS,TREES, FENCES, ETC
c!.i.,,�:!M ON THIS DOCUMENT.I HAVE PERSONALLYI_, �, 1 :�• i�, '�L_ ^ Lt' t� �I LLQ or,
WTZISE SETFORTHONTHISDIFGRAM. �3 2
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279.19-1-8 SEP-000777-2016 j I Ipnl ,jg 2016
Straight, Jack i _
55 Jenkinsville Road `�
Residential Septic Alteration -- —�