2011-393 Oa` TOWN OFQ UEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
Q rY,
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110393 Date Issued: Tuesday, August 09, 2011
This is to certify that work requested to be done as shown by Permit Number P20110393
has been completed.
Tax Map Number: 523400-227-017-0001-024-000-0000
Location: 8 N SEELYE Rd
Owner: MATTHEW & GERALDINE EBERLEIN
Applicant: MATTHEW& GERALDINE EBERLEIN
This structure may be occupied as a:
Test Pit/Perc Test Review
By Order of Town Board
TOWN OF QUEENSBURY
(ThIssuance of this Certificate of Compliance DOES NOT relieve the (2 "74
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f if
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.
1
41�` TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20110393 Application Number: A20110393
Tax Map No: 523400-227-017-0001-024-000-0000
Permission is hereby granted to: MATTHEW&GERALDINE EBERLEIN
For property located at 8 N SEELYE 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 Value
Owner Address: MATTHEW&GERALDINE EBERL
42 N RUGGLES Rd Test Pit/Pere Test Review
SARATOGA SPRINGS,NY 12866 Total Value
-C
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2011-393
deep hole/perc test
$200.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,August 09,2012
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at thewn Quee/3bu ; rT sd ,August 09,2011
I
SIGNED BY aryfor the Town of Queensbury.
Director of Building&Code Enforcement
0.
Town of Queensbury• Building&Codes Enforcement Office■742 Bay Road■ Queensbury,NY 12804
DEEP HOLE/PERC TEST
Request for Town Engineer Review
Property Owner: itA-T' CB Ci J Phone: ¢G°! — 3276
Property Owner's �{
Address: 8 5L'((: R.i / L.4 E edge?C
Location of Test: '#8 'x/02 5`L. L r& k.i Tax ID#: ZZ7. I1 —) — Z4/Z$
*Applicant's Engineer: 2 ' peg, ft Phone: 8rt -O$9R
Applicant's Agent: k\< Er o,t..le(L.\t. I,QLt..c._ Phone:
Additional Notes:
1. Reason for Request? New Septic System ix Replacement Septic System Failed Septic System
Subdivision Site Plan Review
2.Are Wetlands present? YES )( NO UNKNOWN
*Note: Applicant is required to engage an engineer for design and testing of the 1 t1. Ehe faolymW E r
Engineer's responsibility is to witness system testing only.
PLOT PLAN: Plot plan, to scale, to be submitted with application AUG Al 2011 J
FE�i :-� TOWN OF QUEENSBURY
/ ILDING & CODES
a. $200 Flat Fee Date Paid: = .��_,
Check No.:
b. OR Fee to be determined during To Be Determined:
Site Plan /Subdivision review process
SIGNATURE:
In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may
engage the services of a qualified professional consultant for expert review and recommendation arising
from the carrying out of the provisions of Art. IV, including but not limited to the review of plans,
specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep
hole and percolation tests, system installations, and any other aspect of any matter contained in this Art.
IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before
any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an
invoice for same, whichever is sooner. Such costs shall not exceed$1,500 without prior written notice to
the party to be charged with same.
My signature below indicates I have thoroughly read and understand the instructions, agree to the
submission requirements and have completed the application. I also fully understand that additional
engineering fees may be necessary per Town of Queensbury Local Law 136-14D.
SIGNATURE OF APPLICANT: 4,1*-/ ? Date: 6/4-ht
SIGNATURE OF AGENT: Date:
Original (B&C File) Canary(Planning) Pink(Applicant) Gold (Town Clerk)
Aug 08 11 02:28p RIPER 5185813893 p.2
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RK Engineering, PLLC
225 Ruggles Road - Ho°
Saratoga Springs, NY 12866 / /'
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TREATMENT FIELD TIE-IN DIMENSIONS (FT)
STRUCTURE CORNER
A B C D
PROPOSED SEPT1C SYSTEM TREATMENT L
x x
PLOT PLAN INFORMATION OBTAINED FROM OWNM
PROVIDED SITE PLAN AND SCIENECTADY COUNTY GIS.
THIS DRAWING DOES NOT REPRESENT A LAND SURVEY
x AND IIUST NOT BE CONSTRUED AS SUCH.