SEP-000740-2016 TOWN OF QUEENSBURY
742 Bay Road Queensbury,NY 12804-5904 (518)761-8201
r
— Community Development-Building& Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-000740-2016 Date Issued: Thursday, October 27, 2016
This is to certify that work requested to be done as shown by Permit Number SEP-000740-2016
has been completed.
Tax Map Number: 308.16-2-21
Location: 399 CORINTH RD
Owner: Matt Colvin
Applicant: IBS Septic
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEENSSBBURY�j
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, aaayyyjjjllY" V
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
Ise Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000740-2016
Tax Map No: 308.16-2-21
Permission is hereby granted to: IBS Septic
For property located at: 399 CORINTH 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
Tvce of Construction
Owner Name: Matt Colvin Septic Disposal-Residential $0.00
Owner Address: 399 CORINTH 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: Thursday,October 26,2017
(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 ueensbu / / /oVedn r26,2016
SIGNED BY: l•,• _�// �•VJ for the Town of Queensbury.
Director of Building&Code Enforcement
Revised 4/14/2010
OFFICE USE ONLY
TAX MAP NO. PERMIT NO. PERMIT FEE
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 n OF 7}&VALID P RM IT. I R C S p x(17
OWNER:�1 `G 1pI r PT
/Ln/-1 INSTALLER: Di-S JL1111 '
ADDRESS: 1 i� 1� U' ADDRESS: W NC}O(u(Pr- Y•
PHONE NOS. — I PHONE NOS. ) 1 Y
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT BEDROOMS X Gallons r bedroom = TOTAL DAILY FLOW .,
GARBAGEG 11M
1980 or older X 150 = INSTALLED? I V�f
1981-1991 X 130 = SPA OR HOT TU�.r
1992-present X 110 - INSTALLED? IV/I
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT RO NG_Z STEEP SLOPE %SLOPES
✓ SOIL NATURE: SAND LOAM" CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCKIIMPERVIOUS MATERIAL- ATWH TDEPTH?�_
✓ DOMESTIC WATER SUPLY: MUNpI�CIIP'AL WELL(If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS IV IT PER MIINUTE PER INCH impr7
(fest 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: I�QQ 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 E: SOS
ABSORPTION FIELD(WITH N0.2 STONE) Total length
�J_TL Each trench X
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
❑HOLDING TANK SYSTEM Total required rapacity? _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 13629 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 regulations "th respect to this application and agree
to abide by these and Uifement5 of the Town Of Queensbury QUESTIONS? CALL 7618256 OR EMAIL
Sanitary Sewa i Ordinance. 11 codes a caueensburv.net
10-1- VISIT OUR WEBSITE FOR MORE INFORMATION
Signo erson Responsible Date www�ueensburv.net
wn of Queensbury` Community Development Office`742 Bay Road, Queensbury NY 12804
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