SEP-0677-2018 TOWN OF QUEENSBURY
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742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-0677-2018 Date Issued: Friday, November 2, 2018
This is to certify that work requested to be done as shown by Permit Number SEP-0677-2018
has been completed.
Tax Map Number: 266.1-2-57
Location: 29 SUNSET TRL
Owner: Michael Severance
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-0677-2018
Tax Map No: 266.1-2-57
Permission is hereby granted to: IBS Septic
For property located at: 29 SUNSET TRL
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: Michael Severance Septic Disposal-Residential $0.00
Owner Address: 29 Sunset TR 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: Tuesday, October 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 the expiration date.)
Dated at the To eensb ; j•n r tober 29,2018
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SIGNED BY: ' \ for the Town of Queensbury.
Director of Building&Code Enforcement
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SEPTIC DISPOSAL PERMIT APPL CAR'I.OPN i s
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� 742 Bay Road,Queensbury, NY 12804 /�(,,`'"��] 7(�2urcn,burc L rcr-'1"rit-#. �-- O(0 1 / — " k,
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Tax Map ID#: Z((ivt Il OCT 2r2 ee r UCH; Invoice#: 09569 Project Location: -7-q ITU4,t S -r'30-la. U TC)WN OF( J ' ? Yes No
Primary Owners) M k, BUILDING&CODES
Mailing Address 'Z '9- Sons e 7-ra i I
Phone & Email CI X'_'-i-n_4 60 I
Installer/Builder T 65 S eGt(
Mailing Address C f N '1Phone & EmailLovvRcWo,crce` J � lvePn)hiiry, n_scQ`,
Engineer
Mailing Address
Phone & Email •
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Contact Person for Building &Code Compliance: Cl c).Q,c� Phone: I n 65- ,L.4'
RESIDENCE INFORMATION:
Year Built Gallons #of bedrooms X gallons per = total daily flow
per day bedroom Garbage Grinder Yes No
1980 or older 150 V N IV it- Installed? (circle one)
1981-1991 130 N I\ I, p Spa or Hot Tub Yes No
v `1 Installed? (circle one)
1992-Present 110 1 ( 3 3j r
PARCEL INFORMATION: V -�
Topography lat Rolling Steep Slope %Slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth?
Bedrock/Impervious material At what depth? +
Domestic Water Supply _Municipal Well (if well, water supply from any septic system absorption iskpp ft.)
Percolation Test Rate: per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTEM` fOR NEW CONSTRUCTION:
Tank size (n.) '%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 'Z1() ft.; Each Trench_ —5 4 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. I
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PRINT NAME: rY p DATE: IO'LL 6y(
SIGNATURE: DATE: 1 0-'z6�-r 6
Town of Queensbury Building&Code Enfo c ment Revised Marc-Zvi
INSPECTION WORKSHEET (SEP-007740-2018)
Town of Queensbury - Building and Codes - Fire Marshal
742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal
SEP-0677-2018Permit
Case Number:Case Module:
Thu Nov 1, 2018Passed
Inspection Date:Inspection Status:
Charles DyerSeptic
Inspector:Inspection Type:
29 SUNSET TRL266.1-2-57
Job Address:Parcel Number:
Queensbury, NY 12804
Contact TypeCompany NameName
Granted PermissionIBS Septic
Primary OwnerSeverance, Michael
ApplicantIBS Septic
ContractorIBS Septic
Checklist ItemPassedComments
Building Inspector NotesNO
Public Sewer Sign-OffNO
Soil Type: SandYES
Soil Type: LoamYES
Soil Type: ClayNO
Type of Water: Municipal / Well WaterNO
Waterline separation distanceNO
Nov 01, 2018Page (1)
INSPECTION WORKSHEET (SEP-007740-2018)
Checklist ItemPassedComments
Well separation distanceNO
Well Casing Lengt: 50ft +/-NO
Absorbtion Fields: Total LengthYES180 ft
Septic system field above flood plainYES
Septic tanks & pump station anchored in floodNO
zone
Length of Each TrenchYES60 ft
Depth of TrenchesYES18"-20"
Size of StoneYES# 2
Seepage Pits: NumberNO
Size:NO
Stone Size:NO
Building to TankYESExisting tank 4" schd 40
Tank to Distribution BoxYES4" SDR 35
Distribution box to Field / PitYESSDR 35 perforated
Opening Sealed:YES
Nov 01, 2018Page (2)
INSPECTION WORKSHEET (SEP-007740-2018)
Checklist ItemPassedComments
End CapYESLooped
InletOutlet Pipes & BafflesYESExisting inlet/ new outlet
Manholes 12 or less below gradeNO
\[Provide extension collar if Yes\]NO
Locations / SeparationsYES
Foundation to TankYESFrom walk out- 13'
Foundation to AbsorptionYES82 ft see asbuilt
Separation of PitsNO
Conforms as per Plot PlanYES
Engineer Report and As-BuiltNO
ETU Maintenance Contract providedNO
Location of system on propertyYESLeft rear
System Use StatusYES
Dyer, Charles (Inspector)
Nov 01, 2018Page (3)
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SEPTIC PLO—PLAN
I HAVE SEEN OR OBS , VED ALL OBJECTS
SUCH AS HOUSES
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TOWN OF QUEENSBURY .7.- .,,,
BUILDING DEPARTMENT
compliance
Based on our limited examination,
with our comments shall not be constlued as ,
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indicating the plans and specifications are in
full compliance with the Building Codes of ..‹,
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