BOTH-000557-2016 TOWN OF QUEENSBURY
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-000557-2016 Date Issued: Monday, August 29, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000557-2016
has been completed.
Tax Map Number: 309.11-1-8
Location: 108 FOURTH ST
Owner: Louis Garage
Applicant: Straight's Septic Service
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEENSBURY NS
Issuance of this Certificate of Compliance DOES NOT relieve the / \ �, I�/ 4
property owner of the responsibility for compliance with Site Plan, t���►►►
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-000557-2016
Tax Map No: 309.11-1-8
Permission is hereby granted to: Straight's Septic Service
For property located at: 108 FOURTH 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
Tyne of Construction
Owner Name: Louis Garage Septic Disposal $0.00
Owner Address: 108 Fourth ST Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Straight's Septic Service
1 Myron AVE
South Glens Falls,NY 12803
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-TIES PERMIT EXPIRES: Thursday,August 24,2017
(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 of eensb nVJ y�edn d y,tror
4,2016
SIGNED BY: ' � the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT Office Use Only
DATE AUG 2 3 2016 Received
Tax Map ID
TAxMAPID Permit No. , - S
-97--20117
Permit Fee d
LOCATION OF INSTALLATION /1 Approvals: / \ �j p
APPLICANT S�A1'!?kl.S tiq<< \erwce PHONE/ -MAIN��F�J �D� -V o
I lgonl KoAclSO 6> etusIAIts IU- /za-6o--i �� �3 3
ADDRESS ��^^ I- � �. ,.,,L_
INSTALLER/BUILDER: V l`�r G{�+,5 Jb' 'fC �'�rvlGe PHONE/E-MAILcSti<Y'Ar'f�I1'�-.�aT'••C y
ADDRESS: I /vl4,-0 A) 20A�I �Cau- 1,/6w-' 15Affs, /U.V /2Fo 3
OWNER OLDOI S Getlt PHONE/E-1mL(S-4) 79g+3Z2-9
Address AOR' 1j+1. ST
�QQA.1b�rY
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: PHONE
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older 3 Garbage grinder installed —Y &N
1981-1991 Spa or Hot Tub installed _Y JON
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 1*43 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 4000 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? Tvoe /0 u4 t;o TO-
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 all requirements of the Town of Queensbury Sanitary Sewage Dis osal Ordinancg
Print Name: -?.uKT.5i7Aht DBRSYraihf BSc 'c s rv.cr Date: Z 30 b
Signature: Date: 3 0�
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
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PTI PLOT PLAN
Ro I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES. FENCES, ETC
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