BOTH-000175-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
QL Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000175-2016 Date Issued: Thursday,April 7, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000175-2016
has been completed.
Tax Map Number: 316.13-1-6
Location: 7 BARDIN RD
Owner: Ronald Pellerin,Kelly Pellerin
Applicant: IBS Septic
This structure may be occupied as a: Residential Septic System
By Order of Town Board
TOWN OF QUEENSBBURYA
Issuance of this Certificate of Compliance DOES NOT relieve the r
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 QI.JLENSI3I. RY
712 Bay Road,Queensbury,SII° 12804-5904 (5 18)761.6201
CoMMUtlity Development- Building&Codes (5 18)761-8256
BUILDING PERMIT['
E'errnit Number: BOTH-000175-2016
Tax Map No: 31,6.13-1-6
Pen-nission is hereby granted to..: Ills Septic
For property located at: 7BARDIN RD
On t;he`Towaa of Queensbury,to construct or place at the above location in accordance with application together
with phot plans and other information hereto tiled and approved and in compliance with the NYS Uniform
Building Codes and the Queensbury"honing Ordinance
`:ytte ofQ'onstruction
Owner blame: Kelly Pellerin Septic Disposal $0,00
Owner Address: 7 Bardin DR 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 System
$40.00 PER.MI I IEE PAID-THIS PI::;RIwt1't` XPIRES: Friday,March 31,2017
(11'a longer period is required,an application for an extension must be made to the code Enlorcement Officer
of the Town of Queensbury belbre the expiration date.)
Elated at the"town inch~bury; Cue;d yF
5,2016
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SIGNED BY: t,� ,� � � ^� � liar the"Town Of Queensbury.
44
Director of Building&Code Enforcement
P .
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Community Development Office A[-mr4' 4 `fl
W r; Town of Queensbury • 742 Bay Road • Queensbury, New York 1
rOW1 �x Of
Office Use
TAX MAP NtO. C3 I
� PERtwIIT NO. PEFMIT FEE �` ` r� .J1r� "
APPROVALS: ZONING_ �'
APPLIICATION FOR SEPTIC: DISPOSAL SYSTEM PERMIT. A PERMIT MUST BE OBTAINED
i ISSUANCE SOF A VALID PERMIT.INSTALLER: ) "S , -
-
BEFORE WRFC IE�GINrI . A ATItON I SUBJECT TO REVIEW f3)W q
PPLNC
OWNER: _ — -
ADDRESS:
ADDRESS:
PHONE NOS. ✓ a � PHONE N¢ B,_ M _
LOCATION OF INSTALLATION q P Prer ti
_ ___..._..m. RESIDENCE INFORMATION,
TOTAL DAILY FLOW INSTALLED?
NQ.C7F COMPUTATIONYEAR BUILT BEDROOMS � Gallons er bedroom GARBAGE GRINDER
__.
1980 or older X 150
1981 -1991 � X 130 SPA OR HOT TUB
INSTALLED?
1992-present x 11,d
PARCEL INFORMATION:
• TOPOGRAPHY: FLAT RO LING STEEP SL E %SLOPEk
SOIL NATURE: SAND LOAM CLAY_ w OTHER� .� '`�
• GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCKJIM,PERVIOUS MATERIAL,; AT WHIAT DEPTH?
, p
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL . (If well:water supply from any septic system absorption%s: ftl
✓ PERCOLATION TEST: RATE:Is___ PER MIINUTE PER INCH(mpi} (Test to be completed by a licensed professional
engineer or architect)
PROPOSED SYSTEM FOUR NEW CONSTRUCTIOM All ir.&vidual sewage disposal systems must be designed by a licensed professional engineer or
architect(unless installed in a Planning Board approved subd'ivision).
TANK SIZE GALLON (MIN. SIZE IS 1,0700 GAL.)Add 2507 gallons to the size of the septic tank for each garbage grinder,
spa or whirlpool tub.
SYSTEM TYPE:
ABSORPTION FIELD (WITH NO.2 STONE) Total length f1. Each trench ? X
❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size?
to ALTERNATIVE SYSTEM Bed or ether type? ... ,
® HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL
INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
For your protection, please note that pursuant to Section 136-28 of the Code of the Town of Queensbury, anyy"permit or approval
granted which is based upon or is granted in reliance upon any maternal misrepresentation 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 with respect to this application and agree to
abide by the and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
SanitaroS ge Disposal Ordinance. eodesCcr rlueensburw.ruet
VISIT OUR WEBSITE FOR MORE INFORMATION
Sign ktt of Person Responsible Date www.gueensburW.net
FE USON New
York
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Kelly Pellerin 74 0F
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