SEP-000859-2016 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-000859-2016 Date Issued: Thursday, December 29, 2016
This is to certify that work requested to be done as shown by Permit Number SEP-000859-2016
has been completed.
Tax Map Number: 302.17-1-28
Location: 20 WINTERGREEN RD
Owner: Sean Gilhooly
Applicant: IBS Septic
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF
Q�UEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the ( f/
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-000859-2016
Tax Map No: 302.17-1-28
Permission is hereby granted to: IBS Septic
For property located at: 20 WINTERGREEN 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
Tyne of Construction
Owner Name: Sean Gilhooly Septic Disposal-Residential $0.00
Owner Address: 20 WINTERGREEN RD 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
$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 o ueensb uea , 27,2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
LAPPROVALS:
ICE USE ONLY r�r�,, Revised 4/14/2010
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MAP NO. PERMIT NO. PERMIT FEE �t I n'.'4an t lJ
ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OF A VALID PERMIT.
OWNER: 5� U j AJ - f � /JD y INSTALLER: ..l�IJ . J L-(74-1-1
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ADDRESS: ��'^ fes_,' ,� %Eryry^ o f& 41 ADDRESS: ff CO t t,- y
PHONE NOS. —/"� "`—,! d PHONE NOS. / _ f� �
f� Q9 1/ C j / �✓
LOCATION OF INSTALLATION:
YEAR BUILT NO.OF COMPUTATION RESIDENCE INFORMATION:
BEDROOMS X Gallons rbedroom = TOTALDAILYFLOW
1980 or older X 150 _ GARBAGEGRINDER
INSTALLED?
1981-1991 X 130 - -
SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION: bra �/J (�
✓ TOPOGRAPHY: FLAT ROLLING, STEEPSLOPE %SLOPE_ D trip l! LS
✓ SOIL NATURE: SAND LOAM CLAY_ D
TH1�E'R
✓ GROUNDWATER: ATWHATDEPTH? /t//F—
✓ BEDROCKIIMPERVIOUS MATERIAL: AT WHAT DEPTH?
TOWN OF QUEENSBURY
✓ DOMESTIC WATER St IPLY- MUNICIPAL WELL. _(if wall:water supply from i I G& C.DES
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH Imp?
(Test to be pleted by a licensed professional engineer or architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a ficensed professional engineer
or architect(unless installed in a Planning Board approved subdivision).
r
TANK SIZE: d U Q GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the siie of the septic tank for "/V'
each garbage grinder,spa or whirlpool tub.
SYSTEM TYPE:
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length ft Each trench X
❑SEEPA&E PIT(S)(WITH NO.3 STONE) How many? Size?
)(�ALTEF2NATIVE SYSTEM 'Bed or other type?_ ,}/ 30 I
❑HOLDING TANK SYSTEM Total required capacity? Tank size? Number' f 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.
1 have read the regulations with respect to this application and agree
to abide by these and all requirements of the Town of Queensbury QUESTIONS? CALL 761256 OR EMAIL
Sanitary S(eytl/7ge Disposal Ordinan J/ // codes0oueensbury net
/.Y) h/ 0 VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person Responsible Date www.aueensburv.net
Town of Queensbury' Community Development Office` 742 Bay Road, Queensbury NY 12804
TOWN OF QUEENSBURY ) !
BUILDING & C S T. j0 ( p Ti,
Reviewed By:
Date:
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I HAVE SEEN IOR OBSERVED ALL OBJECTS !
SUCH A OUSES, WELLS, TREES, FENCES, ETC i
SHO 0 T41S DOCUMENT.I HAVE PERSONALLY f
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CENTER PROJECT
SERVICES
73 Sheridan Street, Glens Falls, NY 12801
Phone-518-796-2515
December 16, 2016
Project#243
Ivan Bell
IBS Septic
Queensbury,NY 12804
Re: Proposed Replacement Septic
20 Wintergreen Road, Queensbury,NY
Dear Ivan:
At your request we have reviewed your proposed replacement septic system design of the
existing 4 bedroom house at 20 Wintergreen Road, in Queensbury. As per our conversation the
residence has an existing failed septic system.
We have reviewed the proposed replacement septic system design and we agree that a standard
absorption bed is acceptable. Based upon a design flow rate of 440 GPD and a percolation rate of
1 to 5 minutes, you will need a minimum of 489 sf of absorption area. We recommend using 20
ft wide by 30 ft long absorption bed with 4 - 25 ft long laterals. The absorption system can be
constructed with the existing 1,000 gallon septic tank, new distribution box, and 4 inch diameter
perforated pipe and stone.
Please feel free to contact me at 796-2515 if you have any questions and that you for your
assistance with this request.
Sincepp y,
Thomas R. Center Jr, P.E.
CCC E0WG
0c D
TOM OFQUEENSBURY
BUILDING & CODES
302.17-1-28 SEP-000869-2016
Gilhooly, Sean
20 Wintergreen Road
Residential Septic Alteration