SEP-0413-2018 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-0413-2018 Date Issued: Friday, June 29, 2018
This is to certify that work requested to be done as shown by Permit Number SEP-0413-2018
has been completed.
Tax Map Number: 295.18-2-35
Location: 173 AVIATION RD
Owner: Robert Dalaba
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 4 0,4
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
. ;'`- tea i
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
'
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: SEP-0413-2018
Tax Map No: 295.18-2-35
Permission is hereby granted to: IBS Septic
For property located at: 173 AVIATION 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: Robert Dalaba Septic Disposal-Residential $0.00
Owner Address: 173 Aviation 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
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday,June 29,2019
(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 t expiratio ,• to,
Dated at the Town f Quee s ury; ,4 Fr'.., 44.Ile 29,2018
1
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
.
' SEPTIC DISPOSAL PER • s I l _ O 4. • ,fi: se Use Onl
—. -" 742 Bay Road,Queensbury, id 2 04
Town of Qyccncbun•
P:518-761-8256 www, ue n r .nect N p� Z S ,�018 v it#: � ( ' j
Tax Map ID#: :2-I g', i ' 2- 3 ' Permit Fee:$75aLhv ; Invoice#:O600
TOWN OF QUEENSBU RYA
Project Location: f7 3 '11f'i A f= L 4If_OING&CODES ept c Variance? Yes No
Primary Owner(s) 1'l61 ai U u
Mailing Address fl'A 'Vie iitn ki,
Phone & Email h i'&-1 - 00
Installer/Builder I PS 5-en+Ir
Mailing Address14 1la V11 , VA
Phone & Email 51 ' _\ -)9.6—$ i.Y
Engineer
Mailing Address
Phone& Email
Contact Person for Building&Code Compliance: I" � ri Phone: C I J R 61• 2-Y6')
s�
RESIDENCE INFORMATION:
Year Built Gallons #of bedrooms X gallons per =total daily flow
per day bedroom Garbage Grinder Yes No/
1980 or older 150 3 1 -0 9 1 n Installed? (circle one)
1981-1991 130 Spa or Hot Tub Yes Nc'
Installed? (circle one) 1
1992-Present 110
PARCEL INFORMATION:
Topography E J Flat Rolling Steep Slope %Slope
Soil Nature / j Sand Loam Clay Other
Groundwater At witat depth?
Bedrock/Impervious material Alt hat 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 10Od���ga1lbbrnsa(min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length ').CC ft.; Each Trench C) 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 Ordinances
PRINT NAME: r'if )-±0 in) °gi r 6-e [ 1 ADATE: V�� aI
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SIGNATURE: yi i DATE: 6- )-��d(t U
Town of Queensbury Building&Code Enforcemen Revised Marl 2618
Pipeline Specialists JOB:
TEAM j p SHEET •
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BY: • DATE:
'Everett J.Prescott,Inc.
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