BOTH-000232-2016 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: BOTH-000232-2016 Date Issued: Thursday, April 28, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000232-2016
has been completed.
Tax Map Number: 301.6-2-68
Location: 17 WESTLAND AVE
Owner: BRUCE FOX
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 J /J
property owner of the responsibility for compliance with Site Plan, �d
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(toad,Queensbury,NY 12804-5904 (518)761-8201
Community Development - Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: BOTI1-000232-2016
Tax Map No: 301.6-2-68
Pen-nission is hereby granted to: 1135 Septic
For property located at: 17 WESTLAND 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 tiled and approved and in compliance with the NYS Unifonn
Building Codes and the Queensbury Zoning Ordinance
Type of Construction
Owner Name: BRUCE FOX Septic Disposal $0.00
Owner Address: 17 Westland.AVE "Dotal Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
IES Septic
2 WARREN ST
Glens Falls,NY 12801
Plans&Specifications
Residential Septic Alteration
$ 40.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday, April 21, 2017.
(Ifa 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 rQ buryp 4 T*avoil-26,2016
SIGNED BY: for the Town of Queensbury.
Director of Building& Code Enforcement
Crlt�Imurifi�r DevelopmentCIC
p !KK NYNNMtYW firwra MA Www '.N' , ✓r n
Town of Queensbury - 742 Bey Road . sbury�, New York -12
Office Use On
TAX MAP NO. PERMIT NO. ";F
APPROVALS: ZONING TOWN CLE
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE W RK BEGINS.APPLICATIONIS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
OWNER: ,A—
INSTALLER: P
ADDRESS: �I L� � @J ADDRESS: d k � a ry' ('�
PHONE NOS. I PHONE NOS. �` "
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT NO.Cil` X COMPUTATION TOTAL DAILY FLOWW
BEDROOMS Gallons per bedroom, GARBAGE GRINDER
1580 or older x 150 - INSTALLED?
1981 -1991 X 1.30 SPA OR HOT TUB
1992-present X 1110 = INSTALLED?
PARCEL INFORMATION:
✓ TOP'OG'RAPHY: FLAT RO lNG STEEP SLOPE %SLOPE
0 If 8
✓ SOIL NATURE: SAND LOAM CLAY � 1 OTHER
• GROUNDWATER: AT WHAT DEPTH? �
✓ BEDROCKAMPERVIOUS MATERIAL: AT WW AT DEPTH? I "
✓ DOMESTICWWATER SUPLY: MUNICIPAL WWELL [�(if well:water supply from any septic system absorption is:NA ft
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpi] (Test to be completed by a Licensed professional
engineer or architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION. All sewage disposal systems must be designed by a licensed professional engineer or
architect(unless installed in a Planning Berard approved subdivision).
TANK SIZE: GALLON(M'IN. SIZE IS 1,000 GAL,)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa or whirl pool tub.
SYSTEM 4E:
ABSORPTION FIELD('WITH NO.2 STONE) Total length ft. Each trench o X
EP SEEPAGE PIT(S)(WITH NO. 3 STONE) Haw many? Size? a4
*ALTERNATIVE SYSTEM Bedor other type?
* HOLDING TANK SYSTEM Total required capacity? It 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 136-29 of the Code of the Town of Queensbury, any`permit or approval
granted which is based,upon or is granted in reliance upon any material,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 these and I requirements of the Town of Queensbury QUESTION'S? CALL 761-8256 OR EMAIL
Sonia S wa a poral Ordinance, VISIT OUR WEBSITE FOR
ne
OR MORE INFORMATION.
Sig,natur'e of rson Responsible Date www.gueensbury.net
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NEW'ING:tON, CT GRfJTU11 CT BRIDGEPORT CT NEW MILFORD, CT CWTON, t M NORTH 11ARWIC11,MA
124 Costello Road 86 Bridgestreet 9 Island Brook?Ave. 506 I7arehtary Road 2 Whitman Road 518 Depot Street
(860)666-5634 (860)405-0146 (203)384-9402 (860)354-02ZI (781)828-1350 (508)430-1690
WORCESTER,MA IVATERIDWN,NY" CLIFTON PARK,NY SYRACUSE,NY NORTHEAST
57 Sauth:rrest Cutoff 800 Starbuck Aug, 612 Pieer•ce Road 6040 Dratt 17°itre PLANT DIVISION
(508)754-2027 (315) 782-378.5 (518)877-30186 (315).374-3583 (877,) 7.54-2107
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