SEP-0527-2018 "Ark
TOWN OF QUEENSBURY
1 4'
‘, 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-0527-2018 Date Issued: Tuesday, August 21, 2018
This is to certify that work requested to be done as shown by Permit Number SEP-0527-2018
has been completed.
Tax Map Number: 301.6-1-25
Location: 34 QUEENS LN
Owner: William Sprague
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 orc nt
Planning Board or Zoning Board of Appeals.
i TOWN OF QUEENSBURY
f -4 A F -
jn ; 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: SEP-0527-2018
Tax Map No: 301.6-1-25
Permission is hereby granted to: Sanitary Sewer Service
For property located at: 34 QUEENS LN
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: William Sprague Septic Disposal-Residential $0.00
Owner Address: 34 Queens LN 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: Thursday,August 15,2019
(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 To ' of Que bury II W'd I e I. • gust 15,2018
41
SIGNED BY: • for the Town of Queensbury.
Director of Building&Code Enforcement
Sys
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�- i` SEPTIC DISPOSAL PIR A . , Wit--Use.a..t.�. Oniv
Y,, , 742 Bay Road,Queenshun 3s NY I '"
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Tax Map 1D th O/e 6 - / - 2-s' I
�� " AUG 15 �p"�Pe t �" F e:$ 7g. co; invoice#: a 7-7 Z
Project Location: Y fee,vf _TO tic Va lance? Yes No
II EN,*EL!;'
Primary Owner(sj ouiLDlNu e,CODES
Mailing Address ,a to ee. s. co-A- - �efee, --sb ii. i-- 1 Z z'
Phone &Email S[ - '"2--,k- 62cf?
Installer/Builder Sa;t:livi f t �Je,- -'lc e
Mailing Address PO . £ .. 2-2 i // f i-7g-.. / / f 2��
Phone &Email c-! f-_ 77( ..-f 7 o
Engineer
Mailing Address
Phone & Email ,
Contact Person for Building«Code Compliance: Ceel C. Are-g-i- Phone: 11F-ii6---,7,76es
RESIDENCE INFORMATION: -
Year Built- #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes Ig
1980 or older - Installed? (circle one) }�
1981-1991ii. ��� � � Spa or Hot Tub Yes Np,
Installed? (circle one)
1992-Present
PARCEL INFORMATION:
Topography . ( Flat Rolling Steep Slope %Slope
Soil Nature Y Sand Loam Clay Other
- Groundwater At what depth? ,4-4
Bedrock/Impervious material At what depth? fr
Domestic Water Supply X-Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: 7--.( per minute per inch(test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size � 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 St. 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 ail requirements of the Town of Queensbury Sanitary Sewage
Disposal f Ordinanc6eO
(`�' L�'J PRINT NAME: ge DATE: F f---7 f---
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SIGNATURE: DATE: ?"--i J mi F-
Town of Queensbury Building&code Enforcement Revised February 2017
. [ECE11 %ffiElf)) '
AUG 15 2018 fiji .
TOWN OF QUEENSBURY 7"
BUILDING&CODES ,.
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FILE COPY
SEPTIC PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES,WELLS,TREES, FENCES, ETC
SHOWN ON THIS DOCU NT.I HAV PERSONALLY
MEA U ED THE DISTANCE TIORT..g0 NIAGRAM. _ J 3 — J ,x,
SIGNATURE DATE
OWN OF QU EIS I 301.E-1-25 SEP-0527-2018
St�ILDIi G t COD :4? S rague, William
P
Reviewed B• y: i 34 Queens Ln
{ Date: v ,. ,. .,I Residential Septic Alteration