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SEP-000388-2017 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-000388-2017 Date Issued: Thursday, July 6, 2017 This is to certify that work requested to be done as shown by Permit Number SEP-000388-2017 has been completed. Tax Map Number: 301.7-2-7.1 Location: 7 FARR LN Owner: Kit Burkich Applicant: IBS Septic This structure may be occupied as a: Residential Septic Alteration current 1 bedroom cabin By Order of Town Board septic tank installation to accommodate future TOWN OF QUEENSBURY 4 bedroom home. Leach field constructed to later be expanded for larger home and increase in number of bedrooms. Issuance of this Certificate of Compliance DOES NOT relieve the ` / 1 _ t/ // dot property owner of the responsibility for compliance with Site Plan, %/f-y 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 L 742 Bay Road Queensbury,NY 12804-5904 (518)761-8201 r Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: SEP-000388-2017 Tax Map No: 301.7-2-7.1 Permission is hereby granted to: IBS Septic For property located at: 7 FARR LN 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: Kit Burkich Septic Disposal-Residential $0.00 Owner Address: 7 Farr LN Total Value $0.00 Queensbury,NY 12804 Contractor or Builders Name/Address Electrical Inspection Agency IBS Septic 2 WARREN ST Glens Falls,NY 12801 Plans&Specifications Residential Septic Alteration current 1 bedroom cabin septic tank installation to accommodate future 4 bedroom home. Leach field constructed to later be expanded for larger home and increase in number of bedrooms. $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,July 3,2018 (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 /,�Jq/Mon h ,J 3,2 17 SIGNED BY: `( (A4{rr Y for the Town of Queensbury. Director of Building&Code Enforcement � Cr� LLu � l � �;. Community Development Office Town of Queensbury • 742 Bay Road • Queensbury, New York -1231 Office Use Onlv TOWN Or ,,UEENSBURY 3 lnI 7 COMAfIJN'PY DEVELOPMENT TAX MAP NO. 30V7-.)-7, 1 r PERMIT NO. 1'n d / PERMIT FEE APPROVALS: ZONING TOWN CLERK /A✓Ot er- X00 APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE RK BEGS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: I f II C, INSTALLER:T�{J2-5 55 ++11 ADDRESS: . ` ADDRESS: TTr 1eC QWq(A�C(CP`�Sl • ��� PHONE NOS. d O I PHONE NOS. tl LOCATION OF INSTALLATION: r RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS Gallons r bedroom GARBAGE GRINDER 1980 or older X 150 INSTALLED? 1981 -1991 X 130 = SPA OR HOT TUB 1992-present X 110 = INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLINGJ STEEP SLOPE_ %SLOPE_ ✓ SOIL NATURE: SAND, LOAM CLAY_ OTHER ✓ GROUNDWATER: AT WHATDEPTH? ✓ BEDROCWIMPERVIOUS MATERIAL: AT WHA DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL_(if well:water supply from any septic system absorption is, ft) ✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpil (Test to be completed by a licensed professional engineer or architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: All if vidusl sewage disposal systems must be designed by a Ilcensed professional engineer or architect(unless installed in a Planning Board approved subdivision). . TANK SIZE:Ij�a_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 D : ITABSOR -,PTION FIELD(WITH NO. STONE) Total length�_ft. Each trench—I—X _ ❑SEEPAGE 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,anypermit 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 761.8256 OR EMAIL Sanitary w e Dis sal Ordinance. �J�-11 codesAmueensburv.net Sign t ers n Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION www.aueensburv.net • 111 : : 1 ■ ■■■ ■■N ■■�! ■■ ■■ice EEINS_n ■0 EM�ii ■ iii■■ ■ � � n�. ■■n aIN No OEM - ■■■E■i� . ■�s■ EES! � ■ ■■■ EM■�i■ ■ ■ ■ ■■_�� - �", nNNEON moll n n■ ■n� ■�■ n■■nM■■ OE■ ■■MEMO■i�E`■�■ 1, r■E ■ NOON ■■■■■■■n■■ a . ■/■� ■■NEON.. 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