SEP-0604-2018 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-0604-2018 Date Issued: Thursday, September 27, 2018
This is to certify that work requested to be done as shown by Permit Number SEP-0604-2018
has been completed.
Tax Map Number: 301.12-1-42
Location: 31 HELEN DR
Owner: Ellen Young
Applicant: Sanitary Sewer Service
This structure may be occupied as a: Residential Septic Alteration (tank only)
By Order of Town Board
TOWN OF QUEENSBURY
(s°116j 4 .4.1
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.
...110b4 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-0604-2018
Tax Map No: 301.12-1-42
Permission is hereby granted to: Sanitary Sewer Service
For property located at: 31 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: Ellen Young Septic Disposal-Residential $0.00
Owner Address: 31 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(tank only)
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Monday, September 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 expiratio a%te,
Dated at the Town Quee ury; 4
F '+., 4 y.tember 21,2018
t - \
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC 3I5PCsAL PERMIT AiP'P lCA l ION Office Use Oniv
p- ` 742 Bay Road,Queensbury,NY 12804 wi:)
rHt7}oftzwn.42Iw .Y.,'� q�G •ti -: Permit#: ll,0 `'
p:51g-76 -SG56 ',inri.-.5 �....sl..:1'-r.:ice<.
-75.1"c
Tax Map ID#: ,3 01. /4 /' �f Z- Permit Fee:$ `� ;invoice#:G2e.3
i7e F l' 't'erl
Project Location:'/ /s&(e 0 - V/2. t_j 3 Septic Variance? Yes No
Primary Owner(s) E L (e r, You ,,.-
Mailing Address 3l /li=/e i ee.vil) cc. /2 yo y
Phone &Email cr f- 23 2 _ I o 9
Installer/Builder ,.,ri9 n-s t.lr'� fe-ev-ec ,./'�`'vr c
Mailing Address ,op . do Zz 'r 6-/e ,,.1 /4 /11 ,Fo/-
Phone «Email S7 I- 7?6 .77,s‘O 1-it z.:r:� . .. . i
j 5
1 ;I
Engineer X s j� '; ;. II
Mailing Address Li 0, L
• Phone &Email • 3 C. , i, OF '_.:'."w....M-W z4:3 J,
Contact Person for Building&Code Compliance:6Ofy e D rr--0-f. Phone: ST = 7 a
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 L.,f /lc" f8v Spa or Hot Tub Yes
Installed? (circle one)
1992-Present
PARCEL INFORMATION:
Topography 1 K Flat Rolling Steep Slope %Slope
Soil Nature x Sand Loam Clay Other
Groundwater At what depth? /"-5A
BedrocIc/Impervious material At what depth? /,- fa
Domestic Water Supply X Municipal _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 4U-' gallons(min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spajhot tub
System Absorption field with#2 one Total length ft.; Ea Trench ft.
Seepage Pit with#3 stone _ e:
Alternative System Bed or oth�r
Holding Tank System �-_o 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
DATE: i-z0-Yf •
PRINT NAME: 0 T 1)
C
S G TURE:NA P
1 DATE: ( -Z4'` /F
Town of Queensbury Building&Code Enforcement Revised February 2017
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I HAVE SEEN OR OBSERVED ALL OBJECTS
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