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BOTH-000311-2015
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-000311-2015 Date Issued: Friday, January 8, 2016 This is to certify that work requested to be done as shown by Permit Number BOTH-000311-2015 has been completed. Tax Map Number: 296.9-2-20 Location: 31 CEDARWOOD DR Owner: Cassandra O'Donnell Applicant: Sanitary Sewer Service 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 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 OL Community Development-Building& Codes (518)761-8256 BUILDING PERMIT Permit Number: BOTH-000311-2015 Tax Map No: 296.9-2-20 Permission is hereby granted to: George Drellos For property located at: 31 CEDARWOOD DR 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 Tyne of Construction Owner Address: 31 CEDARWOOD DR Septic Disposal $0.00 Queensbury,NY 12804 Total Value $0.00 Contractor or Builder's Name/Address Electrical Inspection Agency George Drellos PO Box 224 Gleas Falls,NY 12801 Plans&Specifications Residential Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,November 4,2016 (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 or@ ueens n /�Tue r 10,2015 SIGNED BY: \ /VJ for the Town of Queensbury. Director of Building&Code Enforcement SEPTIC DISPOSAL PERMIT Office use Only DATE Received cy NOV 1 IMFap ID TUMAP fD I b �2� u u Permit No. 311 -ZO TOWN OFC, Permit Fee t4D Inv • 96 LOCATION OFINSTAL"TIO/N//J BUILDING Approvals: APPLICANT 1. a-SSCQ/��/�Ol O� N PHONE/E-MAIL ,7Z,? L� ADDRESS INSTALER/9ULn PHONE/E-MAL AW-17,49 v/OADDRESS; -rAll /1/� zP'di OWNER l 'G(..I..C1�41�- //L OI Q' A"N e�( PHONE/E-MA / I. Address �� ("eA1"'j/^A ! 9 CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: l��©/�G�2 J PHONE v 376a RESIDENCE INFORMATION Year Bulk #of bedrooms X Gallons per bedroom =Total Daily Flow 1980 or older Garbage grinder Installed _Y �L N 1981-1991 Spa or Hot Tub installed _Y _ 1092-Present PARCEL INFORMTiON Topography _t<jRat rolling _Steep slope _%slope Soil Nature Sand _Loam _Clay _Other Groundwater At what depth? o✓ Bedrock/Impervious Material At what depth? /V/ Domestic Water Supply JV Municipal _Well(If well,water supply from any septic system absorption is_ft.) Percolation Test Rate: _L�_5 per minute per incltoh(test be completed by licensed engineering/architect) PROPOSED SYSTEM Fog NEW CONSTRUCTION Re C a/ i tv1,4t, / 7'0 Tank Size SO"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 L- ft.;Each trench x Seepage Pit with#3 stone How many: :size Alternative System Bed or other type? W It- 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-Bulft plan Is received&approved. The Installed system must match the septic system layout on file-no exceptions. DEc.ARATION: 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. 1 have read the regulations and agree to abide by t�tese and all ulre�erits of the Town of Queensbury Sanitary Sewage Disposal Ordinance. Print Name: %of4 r�PGGII� Date: //-/Q-/I Signature: - Date: /O - /J" Town of Queensbury Bulftg&Codes Septic Disposal Permit July 2014 LD;;;; 2, ; FILE COPY R e viewed Fv: SEPTIC PLOT PLAN I HAVE SEEN OR OBSERVED ALL OBJECTS SUCH AS HOUSES, WELLS, TREES, FENCES, ETC SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY ---- ----- -- MEASURED THE DIS ANCE SET FORTH ON THIS DIAGRAM. SIGNATURE DATE i IoL- Sf- i I ; o I , ti r � M f i