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SEP-0590-2018
A0-0-::: .2,(irk) TOWN OF QUEENSBURY ,, „ ,,,.. -, . , - '`-, I 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 mm _ Community Development- Building& Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: SEP-0590-2018 Date Issued: Thursday, October 11, 2018 This is to certify that work requested to be done as shown by Permit Number SEP-0590-2018 has been completed. Tax Map Number: 295.19-3-11 Location: 5 GILMORE AVE Owner: Robert Meyers 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 i 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 1 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: SEP-0590-2018 Tax Map No: 295.19-3-11 Permission is hereby granted to: IBS Septic For property located at: 5 GILMORE AVE 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 Meyers Septic Disposal-Residential $0.00 Owner Address: 5 Gilmore AVE 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, September 18,2019 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Que-•- r before ex • atio 'at-f, Dated at the Town .f Que' -. • T_-••1 September 18,2018 f SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only 742 Bay Road,Queensbury,NY 1 9.4. i rP,7 - © �YG -- T,v,71 Of(ucrn.Shun- 1 L - P:518-761-8256 www.queensbu yf t c..r ad {( 1 Tax Map ID#: � C �� - // Jfl'i 4 Pe a`til ems: $�.s , (4Invoice#: 3 ,u �1 1 SEP 172018 a ,!Lf/ J Project Location: 5 ( h, �' Se i ar ance? V Yes No Primary Owner(s) I'4 6.:s_,. 4+ iT " tiI I1rY Mailing Address5 6 ir„ y f -1 .--- "-` Phone & Email5 I ‘ — Installer/Builder 2 6 Mailing Address ---)7 law e( Wavnt-N ,_1f' Phone & Email i 6".:1 i ._- '1 IN Engineer TQç ( fA Pr Mailing Address 169 ;fat.; to., R01 adve-en) („c„r„, Phone & Email c� . Contact Person for Building&Code Compliance: / 5ti" i Phone: )Ws` kh 141)C RESIDENCE INFORMATION: Year Built Gallons #of bedrooms X gallons per =total daily flow per day bedroom Garbage Grinder Yes o 1980 or older 150 Installed? (circle one) 1981-1991 130 Spa or Hot Tub Yes l.. Installed? (circle one) 1992-Present 110 -) i ! -33() PARCEL INFORMATION: Topography a t Rolling Steep Slope %Slope Soil Nature - Sand Loam Clay Other Groundwater At what depth? Bedrock/Impervious material At wh t depth? Domestic Water Supply unicipal _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 ( (10 fl 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: ize: Alternative System Bed or other type: t X 0 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 regulatio and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinanc e PRINT NAME: ( _e iDATE: , OP Cs)- --4 SIGNATURE: _ , DATE: j Town of Queensbury Building&Code Enforcement Revised March 2018