SEP-0172-2018 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-0172-2018 Date Issued: Monday, April 23, 2018
This is to certify that work requested to be done as shown by Permit Number SEP-0172-2018
has been completed.
Tax Map Number: 308.6-1-48
Location: 58 BURCH RD
Owner: Mandy Manney
Applicant: Mandy Manney
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
- 41 Community Development-Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: SEP-0172-2018
Tax Map No: 308.6-1-48
Permission is hereby granted to: Nffi Contracting
For property located at: 58 BURCH 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
Type of Construction
Owner Name: Mandy Manney Septic Disposal-Residential $0.00
Owner Address: 58 BurchRD Total Value $0.00
'Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
ML Contracting
34 Warren LN
Queensbury,NY 12804
Plans&Specifications
Residential Septic Alteration
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,April 18,2019
(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 Queen ury; We s ril 18,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
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Tax Map ID#: 72 G�, (9 ` c`kA 35 -r,eAPO O_eF Q_e UE_� i � ermi Fee:$ 75 •bb Invoice#: D a /d
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4 `�_ a -Au `'4. �O-E'.-Se tic Variance? Yes No
Project Location: 1_.�V1 p
Primary Owner(s) i Iir k-t iAn,Q
6 Mailing Address Lt 'J lac\ r)-10 (gZPLf
Phone & Email 5\q- ct. 3-. sit -�
Installer/Builder t L CON13- C`-kC±or
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Phone & Email i g__ q 3 .f g/(0 g 3
Engineer
Mailing Address
Phone & Email
Contact Person for Building&Code Compliance: Phone:
RESIDENCE INFORMATION:
Year Built Gallons #of bedrooms X gallons per =total daily flow
per day bedroom Garbage Grinder Yes /No
1980 or older 150 Installed? (circle one)
1981-1991 130
Spa or Hot Tub Yes ONo
�
Installed? (circle one)
1992-Present 110
PARCEL INFORMATION:
Topography y Flat Rolling Steep Slope %Slope
Soil Nature l/-Sand Loam Clay Other
Groundwater At what depth?
Bedrock/Impervious material At what depth?
Domestic Water Supply i/Nlunicipal _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 engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size f,0OO gallons(min. size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length ft.; Each Trench ft.
Seepage Pit with#3 stone How many: ;Size:
Alternative 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 until such time as an as-built plan is received and approved.
The installed system must match the septic 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 known 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
Disposal Ordinance. (� (�
PRINT NAME: Illa kI" 1fy
1� (A ll'e q DATE: 4/i [i
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SIGNATURE: s dian/vyL-e-t''L�- DATE: `"Ill 1
Town of Queensbury Building&Code Enforcement° Revised March 2018
SEP f"P .AN
I HAVE ISEEN OR OBSERVED ALL OBJECTS j ',
SUCH AS HOUSES,WELLS,TREES, FENCES, ETCB Ci, i t,,,,: ;/ ;✓'
;Ovniid ON THIS DOCUMENT,I HAVE PERSONALLY
I,.- 7' DISTANCE SET FORTH ON THIS AGRA
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{ - 8,: , .,' . .�.. ; .. Date: