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SEP-000610-2017 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-000610-2017 Date Issued: Friday, September 29, 2017 This is to certify that work requested to be done as shown by Permit Number SEP-000610-2017 has been completed. Tax Map Number: 301.8-2-25 Location: 25 COTTAGE HILL RD Owner: Thomas Alberico Applicant: IBS Septic This structure may be occupied as a: Tank Replacement Only 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 so. Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: SEP-000610-2017 Tax Map No: 301.8-2-25 Permission is hereby granted to: IBS Septic For property located at: 25 COTTAGE HILL 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 Tvne of Construction Owner Name: Thomas Alberiao Septic Disposal-Residential $0.00 Owner Address: 44 Lincoln AVE Total Value $0.00 Glens Falls,NY 12801 Contractor or Builder's Name/Address Electrical Inspection Agency IBS Septic 2 WARREN ST Glens Falls,NY 12801 Plans&Specifications Tank Replacement Only $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,September 28,2018 (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 exp' ation date.) Dated at the Town of ueensbrida , er 29,2017 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only 742 Bay Road,Queensbury,NY 12804 r.1.1,„r(,�ICL,,ni rI P:518-761-8256 www.gueensbury.net Permit#: Cal® " Invoice#: Permit Fee: $ '2ZZ4 Tax Map ID#: �% Project Location: Lo t� ( I Septic variance? Yes No Primary Owner(s) Q Mailing Address CD Phone & Email Installer/Builder Mailing Address r r'Q'\ Phone & Email Engineer Mailing Address Phone & Email TO OF _ RY -RI-111 DING COYE§ Contact Person for Building&Code Compliance: I���� Phone: RESIDENCE INFORMATION: Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes No 1980 or older Installed? (circle one) 1981-1991Spa or Hot Tub Yes No Installed? (circle one) 1992-Present PARCEL INFORMATION: Topography Fat Rolling Steep Slope %Slope Soil Nature Sand Loam Clay Other Groundwater At w at depth? Bedrock/Impervious material At hat depth? Domestic Water Supply Municipal _Well (if well,water supply from any septic system absorption is_ft.) ,Perco1MTCn st Rate: per minute per inch (test to be completed by licensed engineer/architect) PROPOSED YS EM FOR NEW CONSTRUCTION: Tank size gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub Absorption field with#2 stone Total length ft.; Each Trench ft. Seepage Pit with#3 stone How many: ; Size: Alternative System Bed or other type: Holding Tank System Total required capacity? ;tank size ;#of tanks NOTES: 1.Alarm system &associated electrical work must be inspected by a Town approved electrical inspection agency; 2. We will no longer allow systems to be covered until such time as an as-built plan is received and approved. The installed system must match the septic layout on file—no exceptions. Declaration:Any permit or approval granted which is based upon or is granted in reliance upon any material representation or failure to make a material fact or circumstance known by or on behalf of an applicant, shall be void. I have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. PRINT NAME: kc�-/' DATE: SIGNATURE: DATE: )_� f Town of QueensburyBuild" Code Enforcement Revised February 2017 �_... .. . _ ,..s. � i � _.�_ .R„ ..._{t.�. _I_++.._ . _.. . ._,.rtrt k MMIT P-W aL aN 301.8-2-25 SEP-000610-2017 I HAVE PERSONALLY MEASURED THE DISTANCE Alberico, Thomas FROM THE PROPERTY LINES TO THE 25 Cottage Hill Rd. I'ROPOEp,STUCTURE(S)OIGN(S Tank Replacement Only SIGNATURE -'r,,✓ AT 4 0 CEEBWE J�- SEP 2 7 2017 TOWN OF QUEENS13 i BUILDING&CODES 1 L' l � _ 7 i ti t ppt t[� 's _ .._ .... _ ':i i — `.1 .. — i. ,._..'a t« 'F s+. pp dr ;i �. ...... { ,2.- i f ��' ice.. 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