SEP-000501-2017 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-000501-2017 Date Issued: Friday, August 18, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000501-2017
has been completed.
Tax Map Number: 308.18-1-57
Location: 54 CHURCH LN
Owner: Michele Colon
Applicant: IBS Septic
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
Planning Board or Zoning Board of Appeals. Director of Building&Code Enforcement
ACA TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000501-2017
Tax Map No: 308.18-1-57
Permission is hereby granted to: IBS Septic
For property located at: 54 CHURCH 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: Michele Colon Septic Disposal-Residential $0.00
Owner Address: 54 N Church LN 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: Friday,August 17,2018
(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 exp tion/date.)
Dated at the Town of eensIm /,phur1 a ust 17,2017
SIGNED BY: V for the Town of Queensbury.
Director of Building&Code Enforcement
QifrC nitffD: evet�oqnnpp''77me f ice T f Q1f2 5sAttFy�+'fl42 oad . Queensbury, New York •12804
Office Use Only ^7 BUILDING &CODES _
TAX MAP NO. PERMIT NO. �1 ��}t PERMIT FEE
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 PERMIT.
OWNER: �� l O O INSTALLER: 1-9/S5'e \� c —
ADDRESS: �i Kl(NeU ADDRESS: 2 r(�V�Uj,
PHONE NOS._ ' I— _` PHOCNEENOS.--) v✓ � l 1
LOCATION OF INSTALLATION: I IYfVT LhVf (r�j l f•
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT BEDROOMS X Gallons per bedroom = TOTAL DAILY FLOW GARBAGE GRINDER
1980 or older X 150 = INSTALLED?
1981 -1991 X 130 = SPA INSTALL
N'I`
HOT Tl��y
1992-present X 110 = Lt`J
PARCEL INFORMATION: /1
✓ TOPOGRAPHY: FLAT ROL NGV STEEP SLOPE_ %SLOPE_
✓ SOIL NATURE: SAND LOAM_ CLAY_ OTHER_
✓ GROUNDWATER: AT WHAT DEPTH? i
✓ BEDROCKIIMPERVIOUS MATERIAL: AT WH T DEPTHVV
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL_(if well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mp] (Test to be completed by a licensed professional
engineer or architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All 1ra:iddual sewage disposal systems must be designed by a licensed professional engineer or
architect(unless installed in a Planning Board approved subdivision).
> Jit'^h�
TANK SIZE: 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 TYPE: t
❑ABSORPTION FIELD(WITH NO.2 STONE) Total lengttl _
Z\1ft. Each trench L o X y5�w atov
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Nom._ Size?
�o
❑ALTERNATIVE SYSTEM Bed or other type? )
❑ HOLDING TANK SYSTEM Total required capacity? _Tank size?-+�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,anypermit 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 readthe re anon with respect to this application and agree to
abide by 5al
II equirements of the Town of Queensbury QUESTIONS 7 CALL 761-8256 OR EMAIL
Sang Ordinance. codesCa)oueensburv.net
7tun Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.oueensburv.net
`, FILE COPY
_ 308.18-1-57 SEP-000501-2017
TOWN OF CUEENSBURY Colon, Michele
54 N. Church Lane
6JCDIi�1G & CODES DEC-L. Residential Septic Alteration
p,�\I(cVved �By! — -- -
TOWN OF OUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be construed as
indicating the plans and specifications are in
full compliance with the Building Codes of
New York State.
. r
i
s
a ( e^• 93000 V 914101lne
XwaSN33no 30 NM01.
SEPTIC PLOT PLAN
i I HAVE SEEN OR OBSERVED ALL OBJECTS
' SUCH AS HOUSES,WELLS,TREES,FENCES, ETC
+" SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY
MEA URED THE TAN E SET FORTH ON THI DIAGRAM.
`` t + ✓4 `±1
SIGNATURE bA
i c V
r