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SEP-000687-2016 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-000687-2016 Date Issued: Thursday, October 13, 2016 This is to certify that work requested to be done as shown by Permit Number SEP-000687-2016 has been completed. Tax Map Number: 301.18-2-27 Location: 11 TIMMONS LN Owner: Joseph Williams Applicant: IBS Septic This structure may be occupied as a: Residential Septic Alteration By Order of Town Board TOWN OF QUEENSBUURY Issuance of this Certificate of Compliance DOES NOT relieve the property owner of the responsibility for compliance with Site Plan, ��yyyyyyFFF"' 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 (5 18)761-8256 BUILDING PERMIT Permit Number: SEP-000687-2016 Tax Map No: 301.18-2-27 Permission is hereby granted to: IBS Septic For property located at: l l TIMMONS LN 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: Joseph Williams Septic Disposal-Residential $0.00 Owner Address: 11 Timmons LN Total Value $0.00 Queensbury,NY 12804 Contractor or Builders 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: Friday,October 6,2017 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensb beforjthee ratio�Jn date.)Dated at the Town o Queens //Th ctober 6,2016 SIGNED BY: �(( for the Town of Queensbury. Director of Building&Code Enforcement Revised 4/14/2010 OFFICE USE ONLY & c. " 3vLIk�-�7 .ao1L c �/ " i TAX MAP NO. PERMIT NO.� PERMIT FEE l Ll OC 1 0 4 2916 � APPROVALS: ZONING TOWN CLERK — W APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: EUII , ut �';'-'uRY -D UG& CODES A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BE ISSUANCE OFFApVALID � IT. C` OWNER: l- \n/t 1 UV`!� I INSTALLER: —, J A C ADDRESS:i ' 1pYYL�� L(y/�/� /� S Int^• ADDRESS: PHONE NOS. O�^ 1 I L !1 T I PHONE NOS. U 0 ) 1 LOCATION OF INSTALLATION: I 1 �M�'C�nn 1 L-(` RESIDENCE INFORMATION: NO.OF COMPUTATION = TOTAL DAILY FLOW YEAR BUILT BEDROOMS X Gallons per bedroom GARBAGEGRINDER 1980 or older X 150 = INSTALLED 1981-1991 X 130 = SPA OR HOT TUB INSTALLED? 1992-present X 110 PARCEL INFORMATION: ��,,tt \\'' ✓ TOPOGRAPHY: FLAT ROWN STEEP SL PEP %SLO ✓ SOIL NATURE: SAND LOAMRft TTTTTT��"""" CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? ✓ BEDROCKfIMPERVIOUS MATERIAL' AT WHAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL—DWELL (If well:water supply from any septic system absorption is*_� ✓ PERCOLATION TEST: RATE IS 'hf�PER MINUTE PER INCH[mp7 (Test to be mpleled by a licensed professional engineer or architect) PROPOSED SYSTEM FOR NEIN 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: It.f��r 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 I q LLL��n TMBSORPTION FIELD(WITH NO.2 STONE) Total length' 1I ft. Each trench ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size? O ALTERNATIVE SYSTEM Bed or other type? O HOLDING TANK SYSTEM Total required capacity?_O�__Tank size? Number of tanks? 1 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 13629 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 r7d�'inanoe. menu of the Town of Queensbury QUESTIONS? CALL 761-6266 OR EMAIL Sanitary.Sewage pos codes(ftueensbury.net VISIT OUR WEBSITE FOR MORE INFORMATION Signatur of Responsible Date wwwaueensbury.net Town of74tr Community Development Office*742 Bay Road, Queensbury NY 12804 ■■■■■■■■■■ ■■■■■■■■■Nl■■■N■ i!! ■ ! ■■■[��■■■■■■E�liii■I �Vliiiii■■N■■■ ■m■�■■�►w■■■■■■■■■■gin ■ ■�- mm PPROMMES ■N■■:'1OVELJ■■l�ME fi�li ■■i■■■ . ■■■■■OMMIS■■■i■■ .., �„ •: ' , 4WiM■■■■■■ 0■■■N■■■■■■■t■■� � ��i■■■■■■■ ■■■■■■■■■■■■■■■i n■N■DY�■■■■■■■ ■■■■■■■tl■�IiiiRll}M�.T:�1 !!�=_!! .- ■■■■■■■■■■ ■■�N■■N■■rl , `i:r ? � ■■■N■■■■■■ ■■■■■■■N■■i"i ;E■MIN■■ ■■ --- i�■■N■■■■■N■■n■■N■N ■■■ • . ■■■■■■o■■■■■■I■■■■N■ no ■■■■■■■N■■■■■i■■ ■ ■■ ■■■■■■■■■■■I■ ■ ■■■ ■ ■ ■ co ■N■■r■■NN■■■■■■■■ ■ ■■■■N■N■■F■N■Nil� !!!■n■ 10 LU co ■i■■■■■■■■■�■■■■■■■w■ ■■■■ ■�■■■oi�i■■■Nn ■■■■n■ rn11 � n �n1■■Ei■■■N■■i■ ■I Iliiil�■■iN■■■fi■ ■■I� Ilra�■ N■■In� �■■ r■■■■N ■■■I - . ■n■■■■iommm■■■ ■ ■■ ■ ■■NN■®■■■■■■■■■■■yi ■N�■i■■i 0 -10 ■■■■■■r■■n ■■■■■■�■■I■ 00 E .2 ME OMEN ■■N■N■■■■IMEN OFN Pop MEMN ME II■■■■ iliii■i■■■■■■■■N■■iii! ■N■■N ■■■■■■■■■N■■■i! ■■■■■■■■ Vin!■■■tea■■■■■■■■N■ �'S Z -Y n