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
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