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SEP-000083-2017 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 .0 Community Development-Building&Codes (5 18) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: SEP-000083-2017 Date Issued: Thursday, March 9, 2017 This is to certify that work requested to be done as shown by Permit Number SEP-000083-2017 has been completed. Tax Map Number: 308.10-2-26 Location: 25 HERALD DR Owner: Matthew Greenholtz Applicant: IBS Septic This structure may be occupied as a: Residential Septic Alteration By Order of Town Board TOWN OF QUEENSSBBURY�J Issuance of this Certificate of Compliance DOES NOT relieve the property owner of the responsibility for compliance with Site Plan, � ` /YI paayyjjYYY VV 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 12804-5904 (518)761-8201 OL Community Development-Building& Codes (518)761-8256 BUILDING PERMIT Permit Number: SEP-000083-2017 Tax Map No: 308.10-2-26 Permission is hereby granted to: IBS Septic For property located at: 25 HERALD 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 Tyne of Construction Owner Name: Matthew Greenholtz Septic Disposal-Residential $0.00 Owner Address: 25 Herald DR 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 $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,March 7,2018 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensburybefore the xpira���ttion da e. Dated at the To of Quee T etarch7,2017 SIGNED BY: ����(((/// for the Town of Queensbury. Director of Building&Code Enforcement Revised 4/14/2010 OFFICE USE ONLY g Q/J TAX MAP NO. 3U6 11 a � PERMIT b 3 (�PERMIT FEE a Y WE �/J APPROVALS: ZONING TOWN CLERK D APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: MA�j (��7 A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJE REVI E 0RE ' i ISSUANCE OF A VALID PERMIT. TO I OMMU OF QUEENSBUR} OWNER: �i INSTALLER: NI LOPMEr ADDRESS: � �f ( - r• ADDRESS: • r PHONE NOS. b PHONE NOS. LOCATION OF INSTALLATION: �N N G - RESIDENCE INFORMATION: NO.OF COMPUTATION YEAR BUILT BEDROOMS X Gallons Per bedroom = TOTAL DAILY FLOW GARBAGE GRINpEi� 1980 or older X 150 = INSTALLED?�„Ol+Ytt_ 1981-1991 X 130 = SPA OR HOTT 1992-present X 110 = INSTALLED? _ PARCEL INFORMATION: '\ (qy ✓ TOPOGRAPHY: FLAT ROL G_ STEEP SLOPEMN N %SLOPE ✓ SOIL NATURE: SAND LOAM TTT��� CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? ✓ BEDROCKfIMPERVIOUS MATERIAL: AT WH DEPTH? - 1/ ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELLY (If well:water supply from any septic system absorption is: It ✓ PERCOLATION TEST: RATE IS;_PER MIINUTE PER INCH[mpiJ (Test to be completed by a licensed professional engineer or architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Ail individual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). TANK SIZE: If" GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,spa or whirlpool tub. SYSTEM E: ABSORPTION FIELD(WITH NO.2 STONE) Total lengthQ ft. Each trench X D SEEPAME PIT(S)(WITH NO.3 STONE) How many? S¢e? O 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 fad 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 all requirements of the Town of Queensbury QUESTIONS? CALL 761.8256 OR EMAIL Sanita wage Dis oral Ordiinnfan^ce. codes(aZaueensburv.net ^lEA 01N V �I 7 VISIT OUR WEBSITE FOR MORE INFORMATION Signature of Per espllKo/�onlllsible Date Www•oueensburv.net Town of Queensbury` Community Development Office742 Bay Road, Queensbury NY 12804 MEN 0 ism 0 . .. . ■ .. . ; �. MEMOM i ..■.. ■ . . .■. . .■.. IN �:� ■■■■■"Imm V 0 . .. ■■■ ■■ MOON NNE A■�: 1■ 10101almomwo-RI.NOf1�� ■ if�■.■■■ ■.■ ■■ ON NONE ■ENE■ 1 ?: .■ ■ ■■■ N■■■ NE ■■ ■■ ■■■C�L�iiCNEG�'N ■■■■ ■. ■■■■.■■C��, . \MNe ■ t E ■.. ■..■.■. ■ . ,. X1111 �M& �. ■.I ■■■■■■.ENE NEIN. r �m � . .■ ■..■ . ..■..... ....■�C__ ■C ..C . . • • • ■EIS'. • . `: . • No■■■■■■.■■■■■■■■■■■.■ • "■"'■'�■■nA NON ■■:■■■ No IM ■moi. ���.1..NN■ ti1�.Na�IJL'l� NMOMEEMMUMN N ■■■N■.... N ■.NN N.■ NE■■■o■■■■■■■■ ■ No 111000r ■ ... .. . . . . ■■C ..■■ NNE . C... .. ■■. ■■C■■■ ■■■ C ■ ■■.gym ..M RE-021 I NOON ■■■■■■ ■. ■■■■ N■ ■■ t■■■■�C-L�NCpm- 110mm MNMmommmolEmOmmmumm■ ■ =NFW��!aE■ ■. 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