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. I T I�y l� codes(iDmueensburv.net
Signa ure o son Responsible Date.► VISIT OUR WEBSITE FOR MORE INFORMATION
www.ciueensbury.net
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