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BOTH-000475-2016 P w E L) a y N w W Q N O � cn U Z I WIC m o0 rT� c�3 8 c .� > a U v� Q Q`� 44-4 O Oin 4-4QnC14 o M U �- Cd - f._._i cr 4. n U to Ln ro Q. v ai en aV4i f.�444 s TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development - Building & Codes (518) 76I-8256 BUILDING PERMIT Permit Number: BOTH-000475-2016 Tax Map No: 308.6-1-9 Permission is hereby granted to: IBS Septic For property located at: 61 BURC14 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 Tune of Construction Owner Name: Cory Leclair Septic Disposal $0.00 Owner Address: 61 Burch RD Total Value $0.00 Queensbury,NY 12804 Contractor or Builder's Name 1 Address Electrical Inspection Agency IBS Septic 2 WARREN ST Glens Falls,NY 12801 Plans&Specifications Residential Septic Alteration 40.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday,duly 25, 2017 (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 th expiration e.) Dated at the Towneeeury; Mo y 25, 2016 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement JUL 2 2 2016 Revised 4!1412010 OFFICE USE ONLY _019 TAX MAF'NO. PERMIT NO. ��� PERMIT FEE APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OFF AA VALID PE MIT. r- f OWNER. v'�+ r INSTALLER: ! ADDRESS: b T L L ADDRESS: PHONE NOS_ 47 PHONE NOS. LOCATION OF INSTALLATION: RESIDENCE INFORMATION: YEAR BUILT NO-OF X COMPUTATION = TOTAL DAILY FLOW 4 BEDROOMS Gallons per bedroom GARBAGE GRINDER 1980 or older X 150 — 1 INSTALLED? 1981-1991 X 130 SPA OR HOT TUB 1992-present X 110 — INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: FIAT ROLLI - STEEP SLOPE 1 t�� %SLOPE ✓ SOIL NATURE: SAND LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? ✓ BEDROCKIIMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ✓ 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 individual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Planning Boar approved subdiv11-.),Xdd n). TANK SIZE: � �` GALLJN(X141 .�6�t IS�1',060? 250 gallons to the size of the septic tank for 0 C\ each garbage grinder,spa or whirlpool tub. SYSTEM TYPE: ❑ABSORPTION.FIELD(WITH NO.2 STONE) Total length ft. Each trench X ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size? ❑ALTERNATIVE SYSTEM Bed or other 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 13&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. have read the regulations with respect to this application and agree to abide by these a d all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL Sanitary Sewage, 1 posal Ordinance. i codes ueensbu .net r VISIT OUR WEBSITE FOR MORE INFORMATION Signal o Per on Responsible Date + +- ueensbu .net Town of Queensbury x Community Development Office742 Bay Road, Queensbury NY 12804 — 31.b'(7 '� ID NO HM13S :3 ' slWISV S AIIVNOS83d 3AVH 1IN3M)bO NO NOHS p OHSdM013 'S33N33 'S3381 'S113N ' n - - cn 0 Q - JI S1D3f90 ilt/ C73AM3S8OW N33S 3AVH I .- ff NV d 1 1 - n 0 122 Ln E - —I FILE COPY tiAli r-H- 1 TOWN O �- F QU � EENS .-� _ _ bRY - BUILDI{� & GOD EjE , --L- By; —L _ — - - — - -Rev�ewJed B �. ©ate: — L - N. II I x joN3�no -AE] P9MGIne� l0 V9Nicnins 3O NMOl 3 NoundISNOo 3O NOav' jna 3H1. BOJ SMli 11V iV 31lS 757``44 _ 103PO8d NO 38 Ol NVId SlHl Y , L { -„ t " C R 4 i S { { J T z _ V O -,_�-'v v--- w—c .�.1-r ar.-.mow-,• --+rn�aw4s+—�i—snc,—.cam-�++..«. ___ _'�-�—r+ � 2 � � F— Q 00 Q s[s lr' PLOT PLAN 0 C tY ca l HAVE SEEN OR OBSERVED ALL OBJECTS '4 k SUCH AS NOUS S, WELLS. TREES, FENCES. ETC �p •� a) SHOWN ON i TIENT.l HAVE PERSONALLY • m MEAS CE SET FORTH ON T �C M, M .J lD rY SIG UR DATE