SEP-000750-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
at Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-000750-2016 Date Issued: Monday, October 31, 2016
This is to certify that work requested to be done as shown by Permit Number SEP-000750-2016
has been completed.
Tax Map Number: 302.14-2-83
Location: 81 DIXON RD
Owner: Mick Prosser
Applicant: Stone Installations
This structure may be occupied as a: Residential Septic Alteration
Current cesspool is cracked and spilling into yard By Order of Town Board
TOWN OF QUEENJ4A�
SBURY
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.
Amk TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
1W
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000750-2016
Tax Map No: 302.14-2-83
Permission is hereby granted to: Stone Installations
For property located at: 81 DIXON 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
Tvoe of Construction
Owner Name: Mick Prosser Septic Disposal-Residential $0.00
Owner Address: 81 DIXON RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Stone Installations
4305 Route 50
Saratoga Springs,NY 12866
Plans&Specifications
Residential Septic Alteration
Current cesspool is cracked and spilling into yard
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,October 27,2017
(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*9ber27,2016
)
Dated at the To Quee ury; [ / A
SIGNED BY: ('�/J��"/ for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT Office Use Onlv
DATE / 7—1U Received
Tax Map ID
TAxMAP ID Permit No. S&P' 1-150' ZW
Permit Fee
LOCATION OFINSTALLATION
APPLICANT O e 6 4 Ci OH ` PHO�N/EIE-MAIL
ADDRESS A.
INSTALLERIBUILDER: ' 4 HS PHONE/E-MAIL Z3z-67o ""7
/ ff
ADDRESS: S ^ t' J0
OWNER t / O L y PHONE/E-MAIL 3071,110
Address ' lee"jiv-4 I 9 7
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: G ✓✓� '� PHONE
RESIDENCE INFORMATION
Year Built If of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older a grinder installed
1981.1991 361 Hot in I d _
1992-Present -
PARCEL INFORMATION BUILDING&CODES
Topography Flat rolling _Steep slope _%slope
Soil Nature and _Loam _Clay _Other
Groundwater At what depth?
Bedrock/Impervious Material At at depth?
Domestic Water Supply Munici al _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 gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub)
System T e Absorption field with42-etonL- Total length__16Z_ft.;Each trench x
Seepage Pit with#3 stone How many: ;size
G pl Cl Itemative System Bed or other type?
Z olding 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 materia act or circumstance know by or on behalf of an applicant,shall be void. I have read the regulations and
agree to abide by these aall requirems is of the Town of Queensbury Sanitary Sewage Disposal Ordinange.
Print Name: �w und,GIG Date: 7-146
Signature: Date: lafZ'7 a
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
OPTICgja P
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I HAVE 5EEN OR OBSERVED Al OBJECTS 302.14-2-83 SEP-000750-2016
SU,H AS HOUSES, WEIS,TREES, ENCS , ETC
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