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SEP-000649-2017 TOWN OF QUEENSBURY ya- 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 -- Community Development- Building& Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: SEP-000649-2017 Date Issued: Wednesday, October 18, 2017 This is to certify that work requested to be done as shown by Permit Number SEP-000649-2017 has been completed. Tax Map Number: 289.11-1-50 Location: 3 HALL RD Owner: Robert Walter Applicant: IBS Septic This structure may be occupied as a: Residential Septic Alteration Tank Only(side of tank has collapsed) By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the (�DJ4 4 t 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-000649-2017 Tax Map No: 289.11-1-50 Permission is hereby granted to: IBS Septic For property located at: 3 HALL 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: Robert Walter Septic Disposal-Residential $0.00 Owner Address: 3 Hall 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 Tank Only(side of tank has collapsed) $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,October 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'ation date.) Dated at the Town of ueensb Wues y ,2017 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only 742 Bay Road,Queensbury,NY 12804 r cL,c,r,.t u,i p:518-761-8256 www.gueensburV.net Permit#: 7 2330 Tax Tax Map ID#: Permit Fee: $ ; Invoice#: Project Location:. Ci OC.GSeptic Variance? Yes No Primary Owner(s) f' Mailing AddresskrW Phone & Email OCT 16 2011 Installer/Builder � Mailing Address �n NT Phone & Email Engineer Mailing Address Phone & Email /( / Contact Person for Building&Code Compliance: ' Phone: �� bl RESIDENCE INFORMATION: Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes N 1980 or older Installed? (circle one) 1981-1991 Spa or Hot Tub Yes N Installed? (circle one) 1992-Present PARCEL INFORMATION: Topography v/ tlat Rolling Steep Slope %Slope Soil Nature Sand Loam Clay Other Groundwater At what depth? Bedrock/Impervious material At what depth? Domestic Water Supply _Municipal _ ell (if well, water supply from any septic system absorption is__?5 ft.) Percolation Test Rate: per minute per inch (test to be completed by licensed engineer/architect) PROPOSED SYYNM F W CONSTRUCTION: Tank sizeCH IWIMAs (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub System A sorption field with#2 stone Total length ft.; Each Trench ft. Seepage Pit with#3 stone How many: ; Size: Alternative System Bed or other type: iHolding Tank System Total required capacity? ; tank size ; #of tanks NOTES: 1.Alarm system &associated electrical work must be inspected by a Town approved electrical inspection agency; 2.We will no longer allow systems to be covered until such time as an as-built plan is received and approved. The installed system must match the septic layout on file—no exceptions. Declaration:Any permit or approval granted which is based upon or is granted in reliance upon any material representation 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 and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. PRINT NAME: " ' DATE: SIGNATURE: A DATE: Town of Queensbury Building&Code Enforcers n Revised February 2017 1N3MO13A30 ,dlNnnmo Aun8SN33no jO NAAol Aoz 9 t 130 c� c �TtC PLOT PLA.N._ I WAVES HOEN USES,WELLS,S TREESERVED AELL JECTS SCH A FENCES, ETC SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY r MEASURED E I CE SET FORTH ON T IbO✓ RAM•{ SIGN U DAT i i ti N Ql C � O CO � LLJ O C O � O � a (j) CJ ALJ I � L a..d x _ 70 LL cn N M t1 z w: f r`••� 1�` 11 f _ t s � .t E M. _. r t 4'