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SEP-000623-2016 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: SEP-000623-2016 Date Issued: Monday, September 19, 2016 This is to certify that work requested to be done as shown by Permit Number SEP-000623-2016 has been completed. Tax Map Number: 308.19-1-29.1 Location: 45 OGDEN RD Owner: Sharon Bapp,Richard Bapp Applicant: Richard Bapp 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 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-000623-2016 Tax Map No: 308.19-1-29.1 Permission is hereby granted to: IBS Septic For property located at: 45 OGDEN RD 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: Sharon Bapp Septic Disposal $0.00 Owner Address: 45 Ogden RD Total Value $0.00 Queensbury,NY 12804 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-TIES PERMIT EXPIRES: Saturday,September 16,2017 (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 ee� / I �JFrid �, ep 6,2016 SIGNED BY: (.^H'-�'`I�// /Q/ for the Town of Queensbury. Director of Building&Code Enforcement Revised 4/14/2010 OFFICE USE ONLY jj ln' TAX MAP NO. PERMIT NO. PERMIT FEE LU 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 OIF.A VALID PE IT. e OWNER r� r' ' h INSTALLER: '5) `,/� C ADDRESS: (� Q ft ADDRESS r'Ce Q �V('V 1, 'i PHONE NOS. --� 43 ` / _(_� 'l1 11,11 A7 PHONE NOS LOCATION OF INSTALLATION: K-` i')V"� ' `� - RESIDENCE INFORMATION: ilm TOTAL DAILY FLOW YEAR BUILT m GARBAGE GR 1980 or older = INSTALLED? 1981-1991 = SPA OR HOT TI�[�/ 1992-present = INSTALLED? > PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLI/Np,//NEEP SLOPE_ %SLOPE_ ✓ SOIL NATURE: SAND V LOAM_ CLAY_ OTHER_ ✓ GROUNDWATER: AT WHAT DEPTH?- p BEDROCK/IMPERVIOUS MATERIAL' AT WHAT TH?A DOMESTIC WATER SUPLY: MUNICIPAL ELL_(If mg:water supply from any septic system absorption is: It PERCOLATION TEST: RATE ISN_PER MuNUTE PER INCH[mp7 (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 licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). TANK SIZE: LOM 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 TWE: C1ABSORPTION FIELD(WITH NO.2 STONE) Total length I J fk Each trench X _ D SEEPAGE PIT(S)(WITH NO.3 STONE) How many? N Size? _ ❑ALTERNATIVE SYSTEM Bed or other type? O HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks? i 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 all requirements of the Town of Queensbury QUESTIONS? 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