SEP-00125-2017 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-000125-2017 Date Issued: Tuesday, April 4, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000125-2017
has been completed.
Tax Map Number: 295.19-2-10
Location: I OWEN AVE
Owner: Janice Dietrich
Applicant: IBS Septic
This structure may be occupied as a: Residential Septic Alt.
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,
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
QL Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000125-2017
Tax Map No: 295.19-2-10
Permission is hereby granted to: Janice Dietrich
For property located at: I O W EN AVE
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: Janice Dietrich Septic Disposal-Residential $0.00
Owner Address: 1 Owen AVE Total Value $0.00
Queensbury,NY
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS Septic
2 WARREN ST
Glens Falls,NY 12801
Plans&Specifications
Residential Septic Alt.
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,March 30,2018
Of a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensb forejtheexation date.)Dated at the Town o uemb /fI'hu d rch 30,2017
SIGNED BY: V for the Town of Queensbury.
Director of Building&Code Enforcement
Revised 4/14/2010
OFFICE USE ONLY
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TAX MAP NO. oZ [S ' (y-z'� PERMITb' ()(]
APPROVALS: ZONING — (JU(J
APPLICATION FOR SEPTIC
t S ��SY1��E RMIT:
A PERMIT MUST BE OBTAINED BER ) O E INS. APP 1 I N IS SUBJECT TO REVIEW BEFORE
ISSUANCE OF A VALID PE IT. t. 11 OF QUEENSB
OWNER: ` DIN
ADDRESS: .ADDRESS: f
PHONE NOS. PHONE NOS.� �n) 8 O
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT NO.OFX COMPUTATION = TOTAL DAILY FLOW
BEDROOMS Gallons per bedroom GARBAGE GRINDER
1980orolder X 150 = INSTALLED?
1981-1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLU G_ STEEP SLOPE_F %SLOPE_
✓ SOIL NATURE: SAND LOAM_ CLAY_ OTHER_
✓ GROUNDWATER: ATWHATDEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL• AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL_(If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS PER MINUTE PER INCH[mp7
(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: LOW 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.
SYSTEM TYPE: -
❑ABSORPTION FIELD(WITH N0.2 STONE) Total length I-ft Each trench X
❑SEEPArME PIT(S)(WITH NO.3 STONE) How many? size?
❑ALTERNATNE 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 regular'o 'th sped to this application and agree
to abide by these I qU ments of the Town of Queensbury QUESTIONS? CALL 761256 OR EMAIL
Sanit Sewag O inance. codesCdaueensburv.net
L� VISIT OUR WEBSITE FOR MORE INFORMATION
Signatur f eesponsible Date www.oueensburv.net
Town f Qr;sury* Community Development Office* 742 Bay Road, Queensbury NY 12804
Pipeline Specialists JOB:
P SHEET
NO.: OF
CALCULATED
BY: DATE:
Everett J. Prescott, Inc.
SCALE:
295.19-2-10 SEP-000125-2017 fp rr
Janice Dietrich
1 Owen Avenue FILE C
Residential Septic Alteration �PY
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JECEOVEO
MAR 2. 9 2017
TOWN OF QUEENSBURY
TOWN OF QUEENS D^n BUILDING& CODES
SWILDING & COD 1jCJ
Reviewed By: '
Date: �� IIOo
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aFPTIC PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS
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SHOWN TH' UMENT.IHAVE PERSONALLY
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