SEP-0473-2018 -- -- --- --- -------- ---- --
TOWN OF QUEENSBURY
t4, t ^ 742 BayRoad,Queensbury,NY 12804-5904 (518)761-8201
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��. Community Development-Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-0473-2018 Date Issued: Wednesday, August 1, 2018
This is to certify that work requested to be done as shown by Permit Number SEP-0473-2018
has been completed.
Tax Map Number: 301.8-1-89
Location: 57 HELEN DR
Owner: John Weinhold
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 Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
J
TOWN OF QUEENSBURY
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,` ,' 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: SEP-0473-2018
Tax Map No: 301.8-1-89
Permission is hereby granted to: Sanitary Sewer Service
For property located at: 57 HELEN 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: John Weinhold Septic Disposal-Residential $0.00
Owner Address: 57 Helen DR 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: Saturday,July 20,2019
(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./ t
Dated at the Town Quee ury; �f Fri.`a � y 20,2018
nieSIGNED BY: ®� ' for the Town of Queensbury.
Director of Building&Code Enforcement
1 ` SEPTOC DISPOSAL PERMIT APF ip7oce c -.ke use Orry
- -: , .r 742 Bay Road Queerisbu DIY '� €f 284 i ;
firm r_;CLu nsburr 9 j Jf2 0 Li73-Z `8
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Tax Map ID#: r'2i 0/ -1- 1 I JUt l it 1 $ 7 57.00
f.O?invoice#:
Project L•cation: j"l e CQ Av 0/2 �A e ` epti t/arianc ? Yes No
Primary Owner(s) /'l try (fie f N/i o C
Mailing Address S-7 lie f ()/2
Phone&Email
Installer/Builder S01-to,1 c - cJo e, de/v/6'e
Mailing Address {gyp. 6e2x- u
Phone & Email t - 72 -3 76d
Engineer
Mailing Address
Phone & Email _
Contact Person for Building&Code Compliance: ct'ge t to 4 phone:Si f-- 7 6--57 t
RESIDENCE INFORMATION:
Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes No
1980 or older Installed? (circle one)
1981-1991 e
//�. 9z Spa or Hot Tub Yes
Installed? (circle one)
1992-Present -
PARCEL INFORMATION:
Topography Flat Rolling Steep Slope %Slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth? /vA
Bedrock/Impervious material At what depth? /t.4-
Domestic Water Supply ;\/Municipal _Well(if well,water supply from any septic system absorption is_ft.)
Percolation Test Rate: >--.C.- per minute per inch(test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size /OW 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 Z?"' ft.
.Seepage Pit with#3 stone How many: ;Size:
Alternative System Bed or other type: T77.1 .re Nf 7 i' '`►- '-'''
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. 7-17-1'6P--
PRINT NAME: & breldsDATE:
DATE: 7- 7- 7 Y
SIGNATURE:
Town of Queensbury Building&Code Enforcement Revised February 2017
TOWN OF QUEENSBURY ��
42)
BUILDING & CO ref
cam.
Reviee _ Sy:
Date: 1 .1,q
TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination,compliance
with our comments shell :'tot be construed as
indicating the plans and specifications are in
full compliance with the building Codes of
New York State.
301.8-1-89 SEP-0473-2018
Weinhold, John r
57 Helen Drive
Residential Septic Alteration
SEPTIC PLOT PLAN ` �.
I HAVE SEEN OR OBSERVED ALL OBJECTS _.<_----- N
SUCH AS HOUSES, WELLS,TREES, FENCES, ETC
SHO*I-ON-THIS DOCUMENT.I HAVE PERSONALLY �/I� �2 I F—
ME 1r DI T-H I IS DIAGRAM. vipb6 s1/4„,
SIGNATURE DATE
. rb) E C E a Wil 1E,.
>tay
IllLafTIIi
82018
TOWN OF QUEENSU RY
BUY a DING&CODES
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