SEP-000008-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-000008-2017 Date Issued: Tuesday, January 17, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000008-2017
has been completed.
Tax Map Number: 308.18-1-53
Location: 1 HONEY HOLLOW RD
Owner: Robert Carpenter,Sara Carpenter
Applicant: IBS Septic
This structure may be occupied as a: Residential Septic Alteration
Complete Failure of System 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: SEP-000008-2017
Tax Map No: 308.18-1-53
Permission is hereby granted to: IBS Septic
For property located at: 1 HONEY HOLLOW 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
Tyne of Construction
Owner Name: Robert Carpenter Septic Disposal-Residential $0.00
Owner Address: 1 HONEY HOLLOW RD 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
Complete Failure of System
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,January 12,2018
(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 expirat' date.)
Dated at the Town of Que nsbury; T4sda J12,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Revised 4/14/2010
OFFICE USE ONLY
TAX MAP NO. PERMIT NO. PERMIT FEE_�3�1W
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: r ^ INSTALLER: L
ADDRESS: ADDRESS:
A 1491
PHONE NOS. _ PHONE NOS.
LOCATION OF INSTALLATION: L
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW t
BEDROOMS Gallons per bedroom GARBAGE GRINDER
1980 or older X 150 = INSTALLED?
1981 -1991 Li X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION: _
✓ TOPOGRAPHY: FLAT ROL G STEEP SLOPE %SLOPE D E 0 V 11
✓ SOIL NATURE: SAND LOAM CLAY THER
lr. kg
✓ GROUNDWATER: AT WHAT DEPTHS tY $ ! p
✓ BEDROCK/IMPERVIOUS MATERIA!: AT W T DEPTH? TOWN OFC�UEtNSBURY
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (if well:water supply from ny septB4WAt [4b8o81Q1(D0 ft)
✓ PERCOLATION TEST: RATE IS hi Ic PER MIINUTE PER INCH[mpi]
(Test to be Foalpleted 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: 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.
�-l)�
SYSTEM TYPE: _
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X
❑SEEPAQE PIT(S)(WITH NO.3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
❑HOLDING TANK SYSTEM Total required capacity?—V� Tank size? Number of tanks?
0
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 raquirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Sewa s Ordinance. codes(Mgueensbury.net
l'• f VISIT OUR WEBSITE FOR MORE INFORMATION
SignTOr/aueensbury
son Responsible Date www.clueensbury.net
* Community Development Office x 742 Bay Road, Queensbury NY 12804
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