SEP-000858-2016 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: SEP-000858-2016 Date Issued: Tuesday, January 3, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000858-2016
has been completed.
Tax Map Number: 295.19-1-59
Location: 19 SUNSET DR
Owner: Renee Pasco
Applicant: IBS Septic
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEENSQ)J4
BURY
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-000858-2016
Tax Map No: 295.19-1-59
Permission is hereby granted to: IBS Septic
For property located at: 19 SUNSET DR
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: Renee Pasco Septic Disposal-Residential 50.011
Owner Address: 19 SUNSET DR Total Value 50.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agenc}
IBS Septic
2 WARREN ST
Glens Falls,NY 12801
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,December 27,2017
(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 the expiration date.)
Dated at the Town ueen ry; n Tu ember 27,2016
SIGNED BY: (�Vyrr/ for the Town of Queensbury.
Director of Building&Code Enforcement
Revised 4/14/2010
OFFICE USE ONLY_ [
TAX MAP 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�/rO�F A VALID PERMIT. / ( r &C",
OWNER: / ` P. /A"�rC L �os S (.D INSTALLER: ^ / )/ D / �J�d f SCI
ADDRESS: I V ti' ( I ADDRESS: -'a lo L.,.e r1. •1
PHONE NOS. : -/7 //3 0 PHONE NOS. k 19 q J
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT BEDROOMS X Gallons per bedroom TOTAL DAILY FLOW
GARBAGE GRINDER
1960 or older X 150 = O INSTALLED?�,
1981-1991 X 130 _ SPA OR HOTTU'B
1992-present X 110 = INSTALLED?IiI
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING, STEEP SLOPE—f °%SLOPE_
✓ SOIL NATURE: SAND_4_ LOAM_ CLAY OTHER_
✓ GROUNDWATER: AT WHATDEPTH7 AIA
✓ BEDROCKIIMPERVIOUS MATERIAL: AT WHAT F3TH?� D IE C a E
✓ DOMESTIC WATER SUPLY: MUNICIPAL VWELL_(If well:water s ady sec�ystem.absorp o I it
✓ PERCOLATION TEST: RATE IS PER MINUTE PER INCH[ pill
(Test to be ccol1rii��o lliiplete�d�by a licensed professional engine r or bi�n� OOF QUEENSBIt R�
PROPOSED.SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal syst deCr�NQ ta'�iiemgseiLR fess' nal engineer
or architect(unless installed in a Planning Board approved subdivision).
TANK SIZE: /do—GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for L f
each garbage grinder,spa or whirlpool tub.
SYSTEM TYPE \ 1
0 ABSORPTION FIELD(WITH NO.2 STONE) Total lengt o—0fl. Each trench X
❑SEEPAUE PIT(S)(WITH NO.3 STONE) How many? Size?
0 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 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 fad 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 th and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Se Disposal Ordinan codesCdaueensburv.net
WVQQ/ - VISIT OUR WEBSITE FOR MORE INFORMATION
S7196(ur;'olftrson'llfesponslble Date
www.aueensbury.net
Town of Queensbury' Community Development Office`742 Bay Road, Queensbury NY 12804
295.19-1-59 SEP-000858-2016
Pasco, Renee
19 Sunset Drive
Residential Septic Alteration n
TOWN OF QUEENSBURY
BUILDING & CE3fE EPT.
Reviewed BY:
Date:
FILE COPY
08
7S -v n s 61
A, � �X � ;�1N� lona �wC r�Nn
v Dg � � p � G
D
TOWN OF OUEENSSI)RY
BUILDING
&CODES
d ' eeprlr PI OT PLAN
J I I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, FENCES. ETC
I I SHOWN 0 THIS DOCUMENT I HAVE PERSON�r�ALLY
MEA UR T DISTANCE SET FORTH ON THhggIA�JA
I I I DATE Cl/l
'Z S {rlrr�,{,�f/,
C � Rr} GL r7
IS
c I
o o
I I
Poo L �
I ,
I I
I � I
iP - f R
EC E 0 V
..._...__._.____..... F7, ,=.
TOWN OF QUEENSBURY
'` BUILDING & CODES