SEP-000445-2017 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-000445-2017 Date Issued: Friday, August 4, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000445-2017
has been completed.
Tax Map Number: 315.5-1-6
Location: 107 WEST MOUNTAIN RD
Owner: Alfred Pettit
Applicant: Sanitary Sewer Service
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEEN,S/B�URY
Issuance of this Certificate of Compliance DOES NOT relieve the / J
property owner of the responsibility for compliance with Site Plan, GWµ/
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: SEP-000445-2017
Tax Map No: 315.5-1-6
Permission is hereby granted to: Sanitary Sewer Service
For property located at: 107 WEST MOUNTAIN 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
Tvce of Construction
Owner Name: Alfred Pettit Septic Disposal-Residential $0.00
Owner Address: 107 West Mountain Rd Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Sanitary Sewer Service
PO Box 224
Glens Falls,NY 12801
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-TIES PERMIT EXPIRES: Friday,July 27,2018
(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 o ueens n Phur d 017
SIGNED BY: �(�trjr(/ �.V! for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT Office use Oniv
DAM Received
Tax Map ID
rAXMAPID Permit No. SEP-445 • Zot'+-
Permit Fee A 414
LOCAT/ONOFINSTALLAnON A@Vovafs IvIVQt A uAo
APPUCANT r" ' L :: e-,,//� �L- fes" PHONE/E-MAIL
ADDRESS / l�
(/0 l�L 'b4- /V-/
INSTALLER/BUILDER v / 7 N G��l���? P%// /fC PHON/E/EMAIL�/ ✓�C� G
ADDRESS: U, i
11)e 7V.
PHONE/E-MAl1
Address () 7 /fPO� J
CONTACT PERSON FOR BUILDIND&CODES COMPLfANCEy/p
' V �-6912 1 �--G C �"� PHONE ��^ ` V
RESNENCEINFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed _Y -kV
1981-1991 3 ��� 3 3 c) Spa or Hot Tub installed _Y 2 N
1992-Present
PARCEL INFORMATION _
Topography _�4_Flatrolling _Steepslope _%slope
Sail Nature _Sand _Loam _Clay Other i
Groundwater Atwhatdepth? /V
Bedrock/Impervious Materiel At what depth? /'/
Domestic Water Supply Municipal _Well(d well,water supply from any septic system absorption is_ft.)
Percolation Test Rate: -L- per minute per inch(test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEWCONSTRUCAON
Tank SizeLSO 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 lengthZ> _ft.:Each trench S`O ' x
Seepage Pit with#3 stone How many. ;size
Aftemative System Bed or other type?
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 unfit such time as an As-Bullt plan is received&approved. The installed system must match the septic system
layout on file-no exceptions.
REciARArroN: 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 tt�ege and all requiy@men �he Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: ( JTY3nt P I) Date: 7--,7
Signature: Date: 7-2,L LZ
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
A-( F r el Pe-f-,L-i �-
(O '7
FF=LEOPY
SEPTIC PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OB!ECTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY
ED THE DIST 1 E SE TH ON THIS R
DIAGAM.
7 _ 7
SIGNATURE DATE
JUL 2 6 2017 I!.
p ra
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OWN OF QU , S
BUILDING & Q
i
Reviewed By. `
a Date:
315.5-1-6 SEP-000445-2017
Pettit, Alfred
- - 107 W. Mountain Rd.
Residential Septic Alteration