SEP-0186-2018 -Ad WOWN fflr�
TOWN OF Q[JEENSBUR.Y
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518) 761-8256
ERTIFIATE OFOMPLIANE
Permit Number: SEP-0186-2018 Date Issued: Tuesday, May t, 2018
This is to certify that work requested to be done as shown by Permit Number SEP-0186-2018
has been completed.
Tax Map Number: 309.14-1-35
Location: 13 RIVER ST
Owner: Kevin Drew
Applicant: Sanitary Sewer Service
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
Planning Board or Zoning Board of Appeals. Director of Building&Code Enforcement
TOWN OF QUEENSBURY
ti
}' 742 Bay Road,Queensbury,NY-12804-5904 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: SEP-0186-2018
Tax Map No: 309.14-1-35
Permission is hereby granted to: Sanitary Sewer Service
For property located at: 13 RIVER 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
Type of Construction
Owner Name: Kevin Drew Septic Disposal-Residential $0.00
Owner Address: 13 River ST 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
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday,April 23,2019
(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 o sbury; / Mo ay 23,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
t r s
� - SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only
742 Bay Road,Queensbury,NY 12804 . icy- n®,Town ofCLccnsbutr Permit`#:-;Le 1 c�'c
P:518-761-825f6 www.ciueensbury.net
Tax Map ID#: 3o /9' 1/ '�/ — g r Permit Fee:$ ; invoice#: 3o9
Project Location: / 3 i' 'f vcr S'-I'e-eA- Septic Variance? Yes No
Primary Owner(s) fr V I ry IJ P-2 ..{y___..�3 -.'F 7�. -
Mailin Address 1 ,,.3 = w. ..
g l3 g.iv.e./ S i` g -
Phone&Email S`2 s - 9i 05--s " i i� ,d APR 2 R KA3
Installer/Builder Sp-Al, -I-A� Je .�✓' Ste;v rc e _ .- ._R .
Mailing Address po 1g o u 5 LRW' to Ai s' /24/(f Jam- /Zci-v/ ..,, �' ` r 3' f,0 MMIE
E a
Phone & Email — 7r 6 3 76. 0 m
Engineer
Mailing Address
Phone & Email
RESIDENCE INFORMATION:
Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes k1980 or older Installed? (circle one)
1981-1991 e3 /lp gr g p Spa or Hot Tub Yes 1\1c,,
Installed? (circle one)
1992-Present
PARCEL INFORMATION: '
Topography x- Flat Rolling Steep Slope %Slope
Soil Nature Sand Loam -Clay Other
Groundwater At what depth? ��l
Bedrock/Impervious material At what depth? .0•64-
Domestic Water Supply b4viunicIpal _Well(if well,water supply from any septic system absorption is_ft.)
Percolation Test Rate: /'- s per minute per inch(test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size KCDV 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 Z80 ft.; Each Trench .S-) ' 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:
)),,,e_a., DATE: 2v 7p-
SIGNATURE: - DATE: 21 ZO t.6
Town of Queensbury Building&Code Enforcement Revised February 2017
309.14-1-35 SEP-0186-2018
Drew, Kevin
13 River Street
Residential Septic Alteration
1 FILE COPY
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Reviewed By: / f._ ;
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SEPTIC PLOT PLAN
tZ. I HAVE SEEN OR OBSERVED ALL OBJECTS
H 2e._� SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
. oK SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY
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MEAS D THE DISTANCE ET FFORR H ON THIS DIAGRAM.
SIG ATURE DATE
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