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BOTH-000418-2015 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-000418-2015 Date Issued: Tuesday, December 15, 2015 This is to certify that work requested to be done as shown by Permit Number BOTH-000418-2015 has been completed. Tax Map Number: 309.10-2-56 Location: 1 NEWCOMB ST Owner: Frank Palangi Applicant: IBS Septic This structure may be occupied as a: Residential Septic Alt. 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 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-000418-2015 Tax Map No: 309.10-2-56 Permission is hereby granted to: IBS Septic For property located at: I NEWCOMBST 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: Frank Palangi Septic Disposal $0.00 Owner Address: I Newcomb ST 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 Alt. $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,December 9,2016 (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 expiration date.) Dated at the Town of Q nsbury, n Trt�sdayk:7-Ithe ,2015 SIGNED BY: � Town of Queensbury. Director of Building&Code Enforcement Community Development Office ', jl y Town of Queensbury A y Rb�d • Qu"eensbury, New York •12804 20 5- 5a Office Use Only � 'j� . (� /1/7 TAX MAP NO. PERMIT NO. Y-0a 'PERMIT FEE O `0I VV APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT. A PERMIT MUST BE OBTAINED BEFORE ORK BEGIN APPLICATION IS SUBJECT TO REVIEW BEFOREISSUANCEOF A VALID PERMIT. OWNER: �n 1 a I G^ INSTALLER:T A -Jc1 0 1n1 /I L ADDRESS: Q' ADDRESS: 110 Ly//V ee"(�(W(, al f PP(� PHONE NOS. '(1 PHONE NOS. LOCATION OF INSTALLATION: M RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS Gallons per bedroom) GARBAGE GRINDER 1980 or olderX 150 = INSTALLED? 1981 -1991 X 130 = SPA OR HOT TUB 1992-present X 110 = INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROU-4GI ROU-4GSTEEP SLOPE" %SLOPED ✓ SOIL NATURE: SAND LOAM, CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? tI ✓ BEDROCK IMPERVIOUS MATERIAL: AT WHA DEPTH? _ ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL_(If well:water supply from any septic system absorption is, ft) ✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpi] (Test to be completed by a licensed professional engineer or architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: All lit—widual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). . TANK SIZE: M_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. p SYSTEM TYPE: O ABSORPTION FIELD(WITH NO.2 STONE) Total lengthloa_ft. Each trench I T X �J ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size? 1 ❑ALTERNATIVE SYSTEM Bed or other type? ❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?a 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,aryipermit 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 then a d,d all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL S He bisposal Ordinance. 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