BOTH-000291-2015 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: BOTH-000291-2015 Date Issued: Tuesday,November 10, 2015
This is to certify that work requested to be done as shown by Permit Number BOTH-000291-2015
has been completed.
Tax Map Number: 295.19-1-1
Location: 3 SYLVAN AVE
Owner: Michael Wendling
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
property owner of the responsibility for compliance with Site Plan,
Variance,or other issues and conditions as a result of approvals by the Dire'cltoif Building&Code E orcerren
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804.5904 (518)761.8201
OL Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000291-2015
Tax Map No: 295.19-1-1
Permission is hereby granted to: IBS Septic
For property located at: 3 SYLVAN AVE
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
Tvce of Construction
Owner Address: 3 Sylvan AVE Septic Disposal $0.00
Queensbury,NY 12804 Total Value $0.00
Contractor or Builder's Name I Address Electrical Inspection Agency
IBS Septic
2 WARREN ST
Glens Falls,NY 12801
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,November 3,2016
(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/S�Jpirati/on date.)
Dated at the Town(f Queen ryE / // M er 9,2015
SIGNED BY: LwWKI/ �.Vl t for the Town of Queensbury.
Director of Building&Code Enforcement
p C E 0 W E
Community Development OfficeNOV 6 6 2015
Town of Queensbury - 742 Bay Road • Queensbury, Ne o k -12804 i
TOWN OF QU Fi
Office Use Oniv I BUILD G 8 ' .. _ .
TAX MAP NO_ PERMIT NO. �aT({ ��Z�PERMOIT FEE '146-` �
APPROVALS: ZONING TOWN CLERK
APPLICAT/ON FOR SEPTIC ®ISPOSAL SYSTEM PERMIT: A PERMIT DUST BE OBTAINED
BEFORE WORK BEGINSAPPLI TION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT_
OWNERN1N3STALLATn10MM-* 3Ss
rNSTALLER:ADDRESVt ADDRES : /PHONE N �� PHONE NOS. —LOCATIOy� !
RESIDENCE INFORMATION:
NO.OF COMPUTATION = TOTAL DAILY FLOW
YEAR BUILT B RDOMS X Gallons per bedroom GARBAGE GRINDER
1980 or older X 150 = INSTALLED?
1981-1991 X — 130 SPA OR HOTTUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
J TOPOGRAPHY: FLAT R�O/y,/�NG /STEEP SLOPE °SLOPE
✓ SOIL NATURE: SAND v LOAM CLAYVe OTHER_U
✓ GROUNDWATER: ATWHAT DEPTH?
✓ SEDROCKIIMPERVIOUS MATERIAL: ATWHA DEPTH?�
✓ DOMESTIC WATER SUPLY: MUNICIPAL_ WELL (if well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS; ER MINUTE PER INCH Imp] (rest 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:JLGALA(MIN.SIZE 151.000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa or whirlpool tub.
SYSTEM TYPE: 1
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length R Each bun _
E3 SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
❑HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
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 these and allrequire erns of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sancta inane. {/-'� codes(doueensburv.net
VISrr OUR WEBSITE FOR MORE INFORMATION
Si on Responsible Date www.Queensburv.net
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