SEP-0688-2018 ,4t ) TOWN OF QUEENSBURY
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__ 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
.---� Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-0688-2018 Date Issued: Wednesday, November 7, 2018
This is to certify that work requested to be done as shown by Permit Number SEP-0688-2018
has been completed.
Tax Map Number: 301.12-3-2
Location: 34 COTTAGE HILL RD
Owner: Paul Tackett
Applicant: IBS Septic
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 (75- ,,40 4
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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.
AfOlIK
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-0688-2018
Tax Map No: 301.12-3-2
Permission is hereby granted to: Paul Tackett
For property located at: 34 COTTAGE HILL 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: Paul Tackett Septic Disposal-Residential $0.00
Owner Address: 34 Cottage Hill RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS Septic
2 WARREN ST
Glens Falls,NY 12801
Plans&Specifications
Residential Septic Alteration
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Monday,November 4,2019
(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 •WI
Dated at the To of Que bury 4 F d.�i'ovember 2,2018
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SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only
,__ 742 Bay Road,Queensbury,NY 128 JrL � Cols Zv
town of(been shun-
P:5i18-761-8256 www.queensbur E C E 1:1 ) 5 -' Q l0
Tax Map ID#: 0 , ‘7_- -- —D--- = : $ `SS-.0 Invoice#: 1057
NOV 01 AllProject Location: 3'1 Go t 1 �1 • r it ( ( Sep a ce? Yes •
No
+QUEENSBURY
Primary Owner(s) Pti t ( Tc 1 BUILDING& CODES
Mailing Address 3 Co-I4GP l-�S I
Phone & Email SIli.....7
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Installer/Builder .5- c eel c
Mailing Address I. ®W tor Wrc - 5+,
Phone & Email S-A t'i 9 --%IN
Engineer
Mailing Address
Phone & Email
Contact Person for Building&Code Compliance: C1^l i) Phone: cin6R40)
RESIDENCE INFORMATION:
Year Built Gallons #of bedrooms X gallons per =total daily flow
per day bedroom Garbage Grinder Yes No
1980 or older 150 Installed? (circle one)
1981-1991 130 Spa or Hot Tub Yes Ni
_Installed? (circle one)
1992-Present 110 + 1 7 141 p
PARCEL INFORMATION: y
Topography ' F t Rolling Steep Slope %Slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth?
Bedrock/Impervious material At what depth?
Domestic Water pply _Municipal _Well (if well, water supply from any septic system absorption is ft.)
Percolation Te Rate: per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED ST �SR NEW CONSTRUCTION:
Tank size 1W rr(( Ilons(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 T[ench‘ ft.
Seepage Pit with#3 stone How many:____k_____; Size: q
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: L C (1) k DATE:
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SIGNATURE: DATE: 1 (Town of Queensbury Building&Code Enforc4',, ,Iff
nt Revised Mart??2018
EC LE U V I,
SEPTIC; PLOT PLAN
I HAVE SEEN -OR OBSERVED ALL OBJECTS0
SUCH AS HOUSES, JELLS, TREES, FENCES, ETC NOV 0 1 2018
SH OV,iN ON IS MENT.I HAVE PERSONALLY
r,FASUR E SET FORTH ON THIS DI RAM. TOWN OF QUEENSBURY
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TOWN OF QUEENSBURY
k o ,k, BUDDING DEPARTMENT
=ased on our limited examination,CompliaR r.
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