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SEP-0006-2018
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-0006-2018 Date Issued: Thursday, January 11, 2018 This is to certify that work requested to be done as shown by Permit Number SEP-0006-2018 has been completed. Tax Map Number: 301.6-2-25 Location: 17 WILLOW RD Owner: TIMOTHY METCALFE 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 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-0006-2018 Tax Map No: 301.6-2-25 Permission is hereby granted to: IBS Septic For property located at: 17 WILLOW 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 Type of Construction Owner Name: TIMOTHY METCALFE Septic Disposal-Residential $0.00 Owner Address: 17 Willow 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 $ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday,January 9,2019 (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 expiration date.) Dated at the Town 9,2018ry u SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement ft SEPTIC DISPOSAL PERMIT APPLICATION Office Use Oniv 742 Bay Road,Queensbury, BUY 12804 �f p:518-761-5256 www.gueensbury.net Permit#: 000b - !_® -'6 Tax Map ID#: Permit Fee: $ �5 ; Invoice#: Project Location: �(� ' Septic Variance? Yes No Primary Owner(s) 1 Mailing Address , Phone & Email —� Installer/Builder Mailing Address Low Pr Vv,; r ^ J W. Phone & Email Engineer Mailing Address PM Phone & Email M G 15 Contact Person for Building&Code Compliance: 11511 11111 Phone: RESIDENCE INFORMATION: Year Built #of bedrooms X gallons per befooXIVIN FA rbage Grinder Yes N 1980 or older SING&CODES Y I stalled? (circle one) 1981-1991 � pa or Hot Tub Yes 1 Installed? (circle one) 1992-Present PARCEL INFORMATION: Topography J lat Rolling Steep Slope %Slope Soil Nature Sand Loam Clay Other Groundwater At at depth? Bedrock/Impervious material At Imhat depth? Domestic Water Supply Municipal _Well (if well,water supply from any septic system absorption is_ft.) Percolation Test Rate: per minute per inch (test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size 5bl-,S gallons(min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub System Absorption field with#2 stone Total length ft.; Each Trench ft. Seepage Pit with#3 stone How many: ;Size: Alternative System Bed or other type: Holding 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: ` P,d A DATE: SIGNATURE: legrI r DATE: Town of Queensbury Building&Code Enforcement Revised February 2017 0 ; FERGUSON New York • Massachusetts Watffworks Connecticut • Rhode Islanc TOWN OF QUE B sPT BUILDING & HAVE SE-B Oft OSS VE© ALL OBJECTS,SUCH AS HOUSES, VI LLS,TREES FENCES, ET-a.t Reviewed By. __ SHCIM�I ON, ~IS',DOCUMENT 1 HAVE PERSONALLY Date: __ _. � T ,DANCE SEA FIRTH DN THIS DI _._ - SIGN -� DATE -- �� -- _ U $ 2tIfa To qF QUEENS ' UILQ/NG& Co UPDES V _. erOp -1 x F'9 4 j I I I - 301.6-2-25 SEP-0006-2018 Metcalfe, Timothy 17 Willow Road - Residential Septic Alteration NEWINGTON, CT GROTON, CT BRIDGEPORT, CT NEW MILFORD, CT CANTON,MA NORTH HARWICH,M 124 Costello Road 86 Bridge Street 9 Island Brook Ave. 506 Danbury Road 2 Whitman Road 518 Depot Street (860)666-5634 (860)405-0146 (203)384-9402 (860)354-0223 (781)828-1350 (508)430-1696 WORCESTER,MA WATERTOWN,NY CLIFTON PARK,NY SYRACUSE,NY NORTHEAST 57 Southwest Cutoff 800 Starbuck Ave. 612 Pierce Road 6040 Drott Drive PLANT DIVISION (508) 754-2027 (315) 782-3785 (518)877-3086 (315)374-3583 (877) 754-2107 — 7-mc, - I cfti f4, T __ S, BUILT : f. 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