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BOTH-000450-2016 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 at Community Development-Building&Codes (518)761-8256 CERTIFICATE OF COMPLIANCE Permit Number: BOTH-000450-2016 Date Issued: Thursday, July 14, 2016 This is to certify that work requested to be done as shown by Permit Number BOTH-000450-2016 has been completed. Tax Map Number: 295.14-1-71 Location: 32 WHIPPOORWILL RD Owner: Dwight James Applicant: IBS Septic This structure may be occupied as a: Septic System Alteration By Order of Town Board TOWN OF QUEENSSBBUR/Y� Issuance of this Certificate of Compliance DOES NOT relieve the property owner of the responsibility for compliance with Site Plan, (G V 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. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5404 (518)761-8201 Community Development - Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: BOTH-000450-2016 Tax Map No: 295.14-1-71 Permission is hereby granted to: IBS Septic For property located at: 32 WHIPPOORWILL 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: Dwight James Septic Disposal $0.00 Owner Address: 32 Whippoorwill RD Total Value $0.00 Queensbury,NY 12804 Contractor or Builder's Name I Address Electrical inspection Agency IBS Septic 2 WARREN ST Glens Falls,NY 12801 Plans&Specifications Septic System Alteration $ 40.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday,July 8, 2017 (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 Townuee ury; , Wed e d , J 13, 2016 SIGNED BY: �Q/ for the Town of Queensbury. Director of Building&Code Enforcement Revised 4/14/2010 OFFICE USE ONLY d TAX MAP NO. N-1 7 PERMIT jbn4 PERMIT FEE JUL I ' 2016 APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANC1 F A VALID PERMIT', *J"D DO�no OWNER: I- ' � INSTALLER: ADDRESS: t P) t i I , ADDRESS: LauvIn E5 UJ Y PHONE NOS. I w PHONE tJDS- LOCATION OF INSTALLATION: RESIDENCE INFORMATION; NO.OF COMPUTATION YEAR BUILT X = TOTAL DAILY FLOW *i I BEDROOMS Gallons per bedroom GARBAGE GRIN E 1980 or older X 150 INSTALLED? 1981-1991 K 130 = SPA OR HOT TU jJ 1992-present X 110 = INSTALLED? PARCEL INFORMATION; + ✓ TOPOGRAPHY: FLAT RflLL1N STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH?_VK ✓ BEDROCKlIMPERVIOUS MATERIAL: AT 7ATXFPTH7 ✓ 1DOMESTIC WATER SUPLY: MUNICIPAWELLA�(If w e[I:water supp1 from any septic sstem absorption is: ft ) r ✓ PERCOLATION TEST: RATE IS�__I� PER MIINUTE PER INCH[mp7 (Test to be completed by a licensed professional engineer or architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). TANK SIZE: GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for Q�(� f��each garbage grinder,spa or whirlpool tub. SYSTEM PE: ABSORPTION FIELD(WITH NO.2 STONE) Total length,L ,/ft., Each trench X 0 SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Y Size? ❑ALTERNATIVE SYSTEM Bed or other type? k t 17 HOLDING TANK SYSTEM Total required capacity? ! Tank size? Numberoftanks? N, I\ NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury,any permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation 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 with respect to this application and agree to abide by thew,an ill requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL Sanitary Sew e D' (i al rdinance. J a coc!2s@gueensbury.net VISIT OUR WEBSITE FOR MORE INFORMATION SLgnatu Iyer Responsible Date www.gueensbury.net Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804 t . NC7 31V� aft JIS 910 S1HlN0 0313S33 V q NVO00Hl,N© MSOVHSS A11NOSU3d DAVH I13Sl p 013 S30N33'S3381'S113M'S3Sf10H SV HOf1S 0 0 SIDY90 11V (13A83S80 HO N3�1� rY NVId 1O3d 01-LdgS : �- E 0 N N Cr7 to r b CV r+-S 0 � �N�Q�tina C] n.0 4p !NMoI V 4t7 I� n �-c u- i-e �T d 1 rt h n ��