SEP-000649-2017 TOWN OF QUEENSBURY
ya- 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
-- Community Development- Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-000649-2017 Date Issued: Wednesday, October 18, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000649-2017
has been completed.
Tax Map Number: 289.11-1-50
Location: 3 HALL RD
Owner: Robert Walter
Applicant: IBS Septic
This structure may be occupied as a: Residential Septic Alteration
Tank Only(side of tank has collapsed) By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the (�DJ4
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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
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000649-2017
Tax Map No: 289.11-1-50
Permission is hereby granted to: IBS Septic
For property located at: 3 HALL 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: Robert Walter Septic Disposal-Residential $0.00
Owner Address: 3 Hall 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
Tank Only(side of tank has collapsed)
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,October 17,2018
(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 ueensb Wues y ,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 cL,c,r,.t u,i p:518-761-8256 www.gueensburV.net Permit#: 7
2330
Tax Tax Map ID#: Permit Fee: $ ; Invoice#:
Project Location:. Ci OC.GSeptic Variance? Yes No
Primary Owner(s) f'
Mailing AddresskrW
Phone & Email OCT 16 2011
Installer/Builder �
Mailing Address �n NT
Phone & Email
Engineer
Mailing Address
Phone & Email /( /
Contact Person for Building&Code Compliance: ' Phone: �� bl
RESIDENCE INFORMATION:
Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes N
1980 or older Installed? (circle one)
1981-1991
Spa or Hot Tub Yes N
Installed? (circle one)
1992-Present
PARCEL INFORMATION:
Topography v/ tlat Rolling Steep Slope %Slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth?
Bedrock/Impervious material At what depth?
Domestic Water Supply _Municipal _ ell (if well, water supply from any septic system absorption is__?5 ft.)
Percolation Test Rate: per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYYNM F W CONSTRUCTION:
Tank sizeCH IWIMAs (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub
System A sorption field with#2 stone Total length ft.; Each Trench ft.
Seepage Pit with#3 stone How many: ; Size:
Alternative System Bed or other type:
iHolding 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: " ' DATE:
SIGNATURE: A DATE:
Town of Queensbury Building&Code Enforcers n Revised February 2017
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