SEP-000792-2016 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-000792-2016 Date Issued: Friday,November 18, 2016
This is to certify that work requested to be done as shown by Permit Number SEP-000792-2016
has been completed.
Tax Map Number: 289.6-1-29
Location: 42 NACY RD
Owner: Thomas Eta
Applicant: Morning Star Septic
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEENSSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, ���yyyjjjllY"
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
r
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000792-2016
Tax Map No: 289.6-1-29
Permission is hereby granted to: Morning Star Septic
For property located at: 42 NACY 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: Thomas Etu Septic Disposal-Residential $0.00
Owner Address: 42 Nacy RD Total Value $0.00
Lake George,NY 12845
Contractor or Builder's Name/Address Electrical Inspection Agency
Morning Star Septic
107 Jewell RD
Gansevoort,NY 12831
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,November 18,2017
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensb re theSextionate.)Dated at the Town of eensb ida ber 18,2016
SIGNED BY: GGGM��� for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT �" f' • e e I
DATE —,,yy-��-- Receive,
TAxMAP ID Perit2011.
LOCATION OF INSTALLATION ;.h,„ �pptld(s:
ro' ;Iet.1a2SVf< - r.rA�
APPLICANT 7A 5'/'L% PHONE/E-MAIL >7T 9 '
ADDRESS
INSTALLER/BUILDER: So,...t PHONE/E-MAIL
ADDRESS:
OWNER PHONE/E-MAIL
Address elfa�nnj h n
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: F.....4 cS'i/Au7 PHONE
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older 'j o j'o 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 _X 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 /Oa*_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&assodatated electrical w rk must be inspected by TO n 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 all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: I&AM2 Date: 11.E 46
Signature: G ^ Date:
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
518-793-2290
Fax#518-793-2115
y,) E-mail: morningstarseptic@hotmail.com
www.morningstarseptic.com
" PTIC 1111111111IRVICE
Date: /�Jrc i L "i r_, " is 107 Jewel Road,Gansevoort, NY 12831
TO:
M A P
r
SEPTIC PLOT PLAN 1
I HAVE SEEN OR OBSERVED ALL 08J€CTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
TOWN OF*.'
SHOWN ON THIS DOCUMENT VE PERSONALLY
BUILDING MEASUREDTHE I SETF RT NTHISDIAGRAM.Reviewed SIG -u I
j__. ._.- --+ I
Date: DATE
I FIL=COPY
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289.6-1-29SEP-000792-2016
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TOWN OF QUEENSBURY
BUILDING& CODES