BOTH-000363-2015 011
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742 Bay Road Queensbury,NY 128045904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000363-2015 Date Issued: Wednesday, November 25, 2015
This is to certify that work requested to be done as shown by Permit Number BOTH-000363-2015
has been completed.
Tax Map Number: 301.12-3-38
Location: 2 HILLCREST AVE
Owner: Laurel Male
Applicant:
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 j 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.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000363-2015
Tax Map No: 301.12-3-38
Permission is hereby granted to: IBS Septic
For property located at: 2 HILLCREST 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 Name: Laurel Male Septic Disposal $0.00
Owner Address: 2 MLLCREST AVE 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
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,November 17,2016
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury befoythee iran.00n date.
Dated at the Town Queens /1 M vember 23,2015
SIGNED BY: �•VJ for the Town of Queensbury.
Director of Building&Code Enforcement
BOTH-000363-2015 `4
Laurel Male
2 Hillcrest Avenue
Residential Septic Alteration IBS Septic 205 Revised 4/14/2010
OFFICE USE ONLY
I��3�0TOWN OF or /
TAX MAP NO. 1 PER IT NO. BUILDItv�.: PERMIT FEE �/� ✓A'[.Q�I o�•f0
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OF A VALID PE�jMIT. I _..++rej / Ty�J
OWNER lit l`2 ale+ INSTALLER: 1II),o �, `
ADDRESS: 1 ADDRESS: 1 L \,ye r \VQV cit ✓`-e(� c)1 -
PU PHONE NOS.
HONE NOS.
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT g DROOMS X Gallons r bedroom = TOTAL DAILY FLOW G,gRBAGE GRI[dpR
1980 or older X 150 INSTALLED?
1981-1991 X 130 = SPA OR HOT
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SL 4A %SLOPEA
,1 SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER AT WHAT DEPTH? N N_ -
✓ BEDROCKIIMPERVIOUS MATERIAL AT WHAT EPTH?,
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL"if well:water supply from any septic system absorption is: it
✓ PERCOLATION TEST: RATE IS: PER MINUTE PER INCH Impq
(Test to be completed by a licensed professional engineer or architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a rimmed professional engineer
or architect(unless installed in a Planning Board approved subdivision).
TANK SIZE: l Qoo GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
a2�ach garbage grinder,spa or whirlpool tub.
SYSTEM TYPE: )I
SORPTION FIELD(WITH NO.2 STONE) Total length & Each trench X JAL[
SEEPAGE PIT($)(WITH NO.3 STONE) How many? — _ S¢e? Q"ff
❑ALTERNATIVE SYSTEM Bed or other typep
❑HOLDING TANK SYSTEM Total required capacity? _Tank size? UE 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 abideby these and all rel irements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary$ewag rdinance. J codesldaueensburv.net
VISR OUR WEBSITE FOR MORE INFORMATION
Signature of �r in Responsible Date www.oueensburv.rlet
Town of(Queensbury` Community Development Office"742.Bay Road, Queensbury NY 12804
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