SEP-000571-2017 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-000571-2017 Date Issued: Tuesday, September 19, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000571-2017
has been completed.
Tax Map Number: 297.18-1-6
Location: 440 RIDGE RD
Owner: Denise DiResta
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 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-000571-2017
Tax Map No: 297.18-I-6
Permission is hereby granted to: IBS Septic
For property located at: 440 RIDGE 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
Tvne of Construction
Owner Name: Denise DiResta Septic Disposal $0.00
Owner Address: 440 Ridge 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
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,September 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 beforjtheex ration date.)
Dated at the Town o Queensb4Tue r 12 2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only
TAX MAP NO. PERMIT NO. -(;l�(� J� /PERMIT FEE � �y • V
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT. A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS APPLICATIQN IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
OWNER: Llr 1 INSTALLER:LA
ADDRESS: Lt ADDRESS: 1 3\.AL�r cl��Ii QG1j r e r\ )L
PHONE NOS. ' � `J� 0 PHONE NOS.
LOCATION OF INSTALLATION: —fir"' j Vl
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS Gallons per bedroom GARBAGE GRINDER
1980 or older X 150 = INSTALLED?
1981 -1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLI STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND k LOAM CLAY OTHER �y
✓ GROUNDWATER: AT WHAT DEPTH? ' 6 I 1
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT EPTH?
✓ DOMESTIC WATER SU PLY: MUNICIPAL WELL(If well:water supply from an4P6cQAe sorption is: t)
✓ PERCOLATION TEST: RATE IS V PER MIINUTE PER INCH[mpil (Test to be completed by a licensed professional
engineer or architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All ir.o;vidual sewage disposal systems must be designed by a licensed professional engineer or
architect(unless installed in a Planning Board approved subdivision).j
TANK SIZE:I1�0 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. —�Ur,^ IK �nl!SL
SYSTEM TYPE:
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X
❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size?
❑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, aryrpermit 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 beh of an applicant,shall be void.
I have read the regulations th respect to this application and agree to
abide by these a all irements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
St��-n
Dis o Ordinance. "1 codes anaueensburv.ne
1 VISIT OUR WEBSITE FOR MORE INFORMATION
Si re of sponsible Date www.gueensbury.net
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j I 297.18-1-6 SEP-000571-2017 -
I DiResta, Denise --
440 Ridge Road —
Residential Septic Alteration
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