SEP-0001-2017 TOWN OF QUEENSBURY
4k 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-0001-2017 Date Issued: Friday, January 6, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-0001-2017
has been completed.
Tax Map Number: 295.14-1-64
Location: 16 WHIPPOORWILL RD
Owner: William Conine
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
property owner of the responsibility for compliance with Site Plan, GGG� vvv
Variance,or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planting 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-0001-2017
Tax Map No: 295.14-1-64
Permission is hereby granted to: IBS Septic
For property located at: 16 WHIPPOORWILL 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
Type of Construction
Owner Name: William Conine Septic Disposal-Residential $0.00
Owner Address: 16 Whippoorwill 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: Friday,January 5,2018
(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 a/xj.ratioAn date.)
Dated at the Town o Queens f/ //Thu nary 5,2017
SIGNED BY: 14 _�V /� for the Town of Queensbury.
Director of Building&Code Enforcement
OFFICE USE ONLY �V i_a0/7
TAX MAP NO. PERMIT NO. PERMIT FEEA/�te�a�/J�. ZREE APPROVALS: ZONING TOWNCLERKAPPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: ODESRYA PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECTqfi
ISSUANCE F A VAL D PERMIT. _ �1
OWNER: I i INSTALLER: R3
ADDRESS: W t ( ADDRESS: j{LoyverWArrPn S
PHONE NOS. L-1 .f n L PHONE NOS.
LOCATION OF INSTALLATION: V W oo/ W 1 I
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEARBUILT BEDROOMS X Gallons Per bedroom = TOTAL DAILY FLOW GARBAGE GR{n(y'DNER
1980 or older X 150 = INSTALLED?
1981-1991 X 130 = SPA OR HOT
1992-present X 110 = INSTALLED? _
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROL G ,_ STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND Lqwk& CLAYJR OTHER
✓ GROUNDWATER: AT WHAT DEPTH? f1p \
✓ BEDROCKIIMPERVIOUS MATERIAL: AT WHA DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL_(If well:vrater supply from any septic system absorption is:it)
✓ PERCOLATION TEST: RATE IS: N t _PER MIINUTE PER INCH Impi]
(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 Board approved subdivision).
TANK SIZE: GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
each garbage grinder,spa or whirlpool tub.
S}t�9
SYSTEM E: �
ABSORPTION FIELD(WITH N0.2 STONE) Total length --ft. Each trench, o X
❑SEEPA&E PIT(S)(WITH NO.3 STONE) How many? Size?
D ALTERNATIVE SYSTEM Bed or other type?
D 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 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 requirements of the Town of Queensbury QUESTIONS? CALL 761.8258 OR EMAIL
Sanitary, ewage Di al Ordinance. 'L 1/ _ codesAgueensbumnet
l�l'6 VISIT OUR WEBSITE FOR MORE INFORMATION
S�lgnatu 9totverson Responsible Date www.aueensburv.net
Town of Queensbury' Community Development Office'742 Bay Road, Queensbury NY 12804
FILE COPY
295.14-1-64 SEP 0001-2017
IBS Septic for William Conine F
(� �; L
16 Whippoorwill Road D
Residential Septic Alteration SEPTIC PLOTP-L,AN
I AAS OEN ORNOBSERVEDSALL OESEETC
CTS
EENSf�NG& CODMO 0 1 THIS DOCUMENT.I HAVE PERSONALLY
MA�UREBIHE DISTANCE SET FORTH ON THIS 171 M.
SIGN
TOWN OFQU S U
B ILDING & O T.
viewed By. r
(ArCA�t ate:
l
kJ All
f
y
�i,,r
c �- zn .
' tH
P
-
ztING C P `l
Q zy
�P
c�
oECEHWE �
TOWN OF OUEENSBURY
BUILDING &. CODES