SEP-0557-2018 011110"-- 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-0557-2018 Date Issued: Monday, October 22, 2018
This is to certify that work requested to be done as shown by Permit Number SEP-0557-2018
has been completed.
Tax Map Number: 295.18-1-70
Location: 178 AVIATION RD
Owner: LARRY Waimon
Applicant: Dan Saville
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, ( A4P �,Y/
?ol't
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.
IOW
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: SEP-0557-2018
Tax Map No: 295.18-1-70
Permission is hereby granted to: Dan Saville
For property located at: 178 AVIATION 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: LARRY Waimon Septic Disposal-Residential $0.00
Owner Address: 178 Aviation RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Dan Saville
P.O.Box 824
Glens Falls,NY 12801
Plans&Specifications
Residential Septic Alteration
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, September 5,2019
(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 Qu sb eye , eptember 5,2018
SIGNED BY: iq for the Town of Queensbury.
Director of Building&Code Enforcement
f
1 SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only
., ` t 742 Bay Road,Queensbury,NY 12804 r�i",, Zr/b
Toren ofQurrncbut 518-761-8256 Permit#: .V., J✓
Tax Map ID#: 2 9S 4" ( 20 Permit Fee:$ 7‘6 ; Invoice#: Oft y
Protect Location: /70 ,4'ic%. 1 Ole Septic Variance? Yes No
Primary Owner(s) '.r/, /V f,� 17/'IAA O
Mailing Address /7 i/i1 ° /AO , Q4.1-ems fisi,iii y Al /z-.5 4
Phone & Email 5'8- 767'67 3. 44.iat.;Vi'6%75d 1/ •K 1)
17)
Installer Builder ��
Mailing Address ,76 01 Qt 0 z , ., 1Lf //k /1'56)/
Phone & Email -�
e- 79
Engineer 1-qt- --- 1 s
Mailing -`
Address
, 'I AUG 31 2018 i ..:j
Phone & Email . U
TOWN OF QUEENSBUi<Y
Contact Person for Building&Code Complia e: Ri Ili DING&CODES 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 .. AC5/Si 360 Installed? (circle one)
1981-1991 130 Spa or Hot Tub Yes Q..‘1_,c)
Installed? (circle one)
1992-Present 110
PARCEL INFORMATION:
Topography \C Flat Rolling Steep Slope %Slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth? ^, -
Bedrock/Impervious material At what depth? /4
Domestic Water Supply \Municipal _Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: G / per minute per inch(test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size risA 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: 3 ;Size: 9k$
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 NAM E: 44 /2 Xl-le?"24,4 DATE:
SIGNA URE: i.)k---"> DATE:
Town of Queensbury Building& de Enforcement Revised March 2018
MAP REFERENCE:
MAP OF A SURVEY MADE FOR ��
DONALD & JENE BROSSEAU
BY: JOHN B. VAN DUSEN
DATED: DECEMBER 14, 1976 IFF AUG 3 1 2018�, U u
TOWN OF QUEENSBURY
0 BUILDING&CODES
S46"20 1 00.E
20.00'
Its
Its
LEGEND:
OIPF - IRON PIPE FOUND
OIRF = IRON ROD FOUND
RCB RT &DIANA /y�/ O BRF - BATHEY ROD FOUND
KING /jq� 0 IRS__ IRON ROD SET/TO BE SET ,
735/27 .� /' �_
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Reviewed By:
.� , Date:
• AREA �O Y
47,902 Sq.Ti. SEPTIC PLOT PLAN
1.10 acres I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
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SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY
M SURE THE DISTANCE �TIIHO��NTHISDI�AIIAI.
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178 Aviation Rd
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(518) 792-8474 New York Lic. No. 50135
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NO. DATE DESCRIPTION owc. NO. 03000
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