SEP-000095-2017 TOWN OF QUEENSBURY
y 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Pertnit Number: SEP-000095-2017 Date Issued: Monday, March 20,2017
This is to certify that work requested to be done as shown by Permit Number SEP-000095-2017
has been completed.
Tax Map Number: 296.17-1-28
Location: 27 CARLTON DR
Owner: Thomas Williams
Applicant: IBS Septic
This structure may be occupied as a: Residential Septic Alteration
Failure of tank(possible new leach field;unknown until digging occurs) By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the r
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
OL Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000095-2017
Tax Map No: 296.17-1-28
Permission is hereby granted to: IBS Septic
For property located at: 27 CARLTON 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: Thomas Williams Septic Disposal-Residential $0.00
Owner Address: 27 Carlton DR 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
Failure of tank(possible new leach field;unknown until digging occurs)
$40.00 PERMIT FEE PAID-TIES PERMIT EXPIRES: Thursday,March 15,2018
(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 expiration date.)
Dated at the Town of Qu e,P u n W( nesd M h 1 2017
SIGNED BY: ( rjfor the Town of Queensbury.
Director of Building&Code Enforcement
296.17-1-28 SEP 95-2017
IBS Septic for Thomas & Nicole Williams
27 Carlton Drive VOMMUNTrYDEV
Septic Alteration (tank) 4 bdrm house 1412010
OFFICE USE Oc/NLY "AN TAX MAP NO)-1(O�(--("-) PERMITNO. PERMIT FEEY
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 O`F A VALID PER^M^IT.
OWNER, j 7f�r 1_I_,_O I ` \/\/ 111 I U M INSTALLER: low
US 5 t I
ADDRESS: �r r ADDRESS:, _lO W C fq 1 p W 12 r-,
PHONE NOS. /1 J� PHONE NOS_�
LOCATION OF INSTALLATION: Ar
RESIDENCE INFORMATION:
NO. COMPUTATION
YEAR BUILT g ROOMS X Gallons er be = TOTAL DAILY FLOW •, GARBAGE GRINDER
1980 or older X 150 = ® INSTALLED?
1981-1991 X 130 = - SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
V TOPOGRAPHY: FLAT ROLLI V STEEPSLOPE %SLOPE_
SOIL NATURE: SAND LOAM_ CLAY_ OTHER_
V GROUNDWATER: ATWHATDEPTH?
SEDROCKIIMPERVIOUS MATERIAL, AT WHAT DEPTH?
V DOMESTIC WATER SUPLY: MUNICIPAL_ WELL_(If well:water supply from any septic system absorption is: K)
PERCOLATION TEST: RATE IS PER MINUTE PER INCH[mw]
(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: J�o GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
+*-� Qc)'� each garbage grinder,spa or whirlpool tub.
SYSTEM TYPE:
o ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench - X
❑SEEPAUE 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 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 regulati with respect to this application and agree
to abide by these an I requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary oral Ordinance. codesrdaueensburvnet
�� � .VISR OUR WEBSrfE FOR MORE INFORMATION
Si ur erson Responsible Date
www.uueensburv.net
To rof Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804
Pipeline Specialists JOB:
SHEET
NO.: OF
1E]P, CALCULATED
BY: DATE:
Everett J. Prescott, Inc.
SCALE:
296.17-1-28 SEP 95-2017 7
IBS Septic for Thomas & Nicole Williams l
27 Carlton Drive D
Septic Alteration (tank) 4 bdrm house I (f tV/
SEPTIC PLOT PLFN A{�„i ? 2091 D
I HAVE SEEN OR OBSERVED ALL OBJECTS TOWN OF
SUCH AS HOUSES,WU'LS,TPEES, FENCES, ETC CpAgMUNl1y DEVELOPMENT
SFJGWN ON THI DOCUMENT.f HAVE PERSONALLY Y
M SU STANCE SET FORTH ON T!
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