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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 ;'f--O7)`2l[)A b 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 i� // ��/i6-f N 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: I � I i Ja �� Qn Lo co f CD O LL j h fn 0 C r l a 00 cvN m � d al II rce A) N Ih1 N � F M [ I � D i r ENSBURY CODES i SEPTICPLOT. pLgN I HAVE SEEN IOR OBSERVED ALL OBJECTS ! SUCH A OUSES, WELLS, TREES, FENCES, ETC i SHO 0 T41S DOCUMENT.I HAVE PERSONALLY f M RE [H'DMANCE SET FORTH ON THIS I G M. � r AT 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