SEP-0529-2018 TOWN OF QUEENSBURY
4 ,1
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Buildinglz Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-0529-2018 Date Issued: Monday, August 20, 2,018
This is to certify that work requested to be done as shown by Permit Number SEP-0529-2018
has been completed.
Tax Map Number: 315.6-2-3
Location: 645 CORINTH RD
Owner: Thomas Durkee
Applicant: Fred Smith
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, (DJ 4 ir
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.
1
TOWN OF QUEENSBURY
;, 1 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: SEP-0529-2018
Tax Map No: 315.6-2-3
Permission is hereby granted to: Fred Smith
For property located at: 645 CORINTH 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: Thomas Durkee Septic Disposal-Residential $0.00
Owner Address: 645 Corinth RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Fred Smith
23 VERMONT AVE
Queensbury,NY 12804
Plans&Specifications
Residential Septic Alteration
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday,August 16,2019
(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; hur..:yt u. st 16,2018
SIGNED BY: 'r„ t for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERIVII IELt ANON f fiz use Only
row ofQmeensG 742 Bay Road,Queensbury,NY ----_.-i
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Tax Map ID#: j Z (A'-2-3 t ee:$ 77i co;Invoice#: r
eicTOWN OF QUEENS
Project Location: (� C((� jd„��' i I Mr r)I in A. L('D- cv riance? Yes No
Primary Owner(s) ral
Mailing AddresskIA\ilA
Phone&Email Sc 1 � 1'D—
ina-alter/Builder b
Mailing Address � Va211tPrpi AUe OP AN /b/
Phone& Email /q 3/
Engineer
Mailing Address
Phone& Email
Contact Person for Building&Code Compliance: gi®" Phone:S 3109(',
RESIDENCE INFORMATION:
Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes 1a�'
1980 or older Pe) ;ow
Installed? (circle one)
1981-1991 Spa or Hot Tub Yes NV
Installed? (circle one)
1992-Present
PARCEL INFORMATION:
Topography N.41at Rolling Steep Slope %Slope
Soil Nature Ni Sand Loam Clay Other
Groundwater At what depth? ; A
Bedrock/Impervious material At vhat depth? fJ p
Domestic Water Supply . jMunicipal _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 //p) gallons(min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub
System bsorption field with#2 stone Total length /c ft.; Each Trench Lib 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: -P $//// DATE: l�
SIGNATURE: 7;11,101 DATE: ri
Town of Queensbury Building&Code Enforcement Revised February 2017
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