SEP-000693-2016 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-000693-2016 Date Issued: Monday, July 31, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000693-2016
has been completed.
Tax Map Number: 296.9-2-19
Location: 33 CEDARWOOD DR
Owner: Joseph Mancini
Applicant: Stone Installations
This structure may be occupied as a: Residential Septic Alteration
(failed system) By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the r 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
�Y Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000693-2016
Tax Map No: 296.9-2-19
Permission is hereby granted to: Stone Installations
For property located at: 33 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
Type of Construction
Owner Name: Joseph Mancini Septic Disposal-Residential $0.00
Owner Address: 33 Cedarwood DR 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
(failed system)
$40.00 PERMIT FEE PAID-TMS PERMIT EXPIRES: Friday,October 13,2017
(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 eensbury, ursd c ,2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT Office Use Only
DATE J0 7 -) d Received
9-O) tq Tax Map ID
TAxMAP to 7(O �m I ] Permit No,
Q //'� Permit Fee � �� aDii�i )nvE).'ce 1135
LOCATION OFINSTALLAT/ON 33 Li C `r`f`^�`�''� Approvals:
APPLICANT I/ S-hnG I ;�p 1 wd-;A1✓.S PHONE/E-MAIL
ADDRESS LFTa• SL'
" Z' 70
INSTALLERBUILDER: �Z oV7CL �S��. II G�-IONS PHONE/E-MAIL 3 L 7
ADDRESS: 430 /L. SO csarcJ05c.
OWNER �Vf�, �' ���< PHONE IL
-/E-MA
Address �3 L�Gd4r1�)JPd Lc. ��acersb r4 N•Y /Moq
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: DT PHONE 3014 7107
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed —Y -2�N
1981-1991 Spa or Hot Tub installed —Y X N
1992-Present RD Q
PARCEL INFORMATION
Topography —XFlat rolling _Steep slope _%slope
Soil Nature Sand Loam _Clay _Other
Groundwater At what depth? Als c. 0
Bedrock/Impervious Material At what depth? oHe A0
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 I 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? ry 57, J3 e
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 Ion
allow systems to be covered until such time as an As-Built plan is received &approved. The installed system must match the septic sy.
layout on file–no exceptions.
DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material represen
failure to make a material fact or circumstance know by or on behalf of an applicant, shall be void. 1 have read the re
and agree to abide by t se and all reiremynts of the Town of Queensbury Sanitary Sewage Disposal O(dinance.
Print Name: J .av , Date: _ W �6
Signature: X Date: 10-7'/K _
Town of Queensbury Bu ding&Cotes Septic Disposal Permit July 2014
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Reviewed By: y �
Date: /� ! lc `/Vol T-t' Seer
PERMI_ T PL.p1 PLA-'!
I HAVE PERSONALLY K1EASUREU"( I�DIS.AIdCE
ROM THE PROPERTY LINES TO THE
pROPOSED ST° CTURE(S) O/R�SIGd(S)
C ��afr()ODQ ; � DATE"
N-TU
KEITH R. MANZ, P.E.
38 High Rock Ave Ste 5E
Saratoga Springs, NY 12866
August 30, 2016
Mr. Dean Burdick, V.P.
Stone Installations
RE: 33 CEDARWOOD DRIVE —Town of Queensbury
Percolation Test Results
Dear Mr. Burdick:
The result of the certified percolation tests performed on 8/30/16 at the
aforementioned lot is as follows;
Result— HIGHEST STABILIZED RATE = 3 minutes per inch.
Sincerely,
of NEW Y
h
ss\ONP
Keith R. Manz, P.E.
KRM/krm 296.9-2-19 SEP 693-2016
Cc: file Mych Ellis - Stone Installations
33 Cedarwood Lane
Residential Septic Alteration - failed system
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