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SEP-000419-2017 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-000419-2017 Date Issued: Tuesday, September 18, 2018 This is to certify that work requested to be done as shown by Permit Number SEP-000419-2017 has been completed. Tax Map Number: 301.20-2-1 Location: 45 47 51 53 Queen Mary DR Owner: Queen Victoria Grant Homeowners Assoc. Applicant: IBS Septic This structure may be occupied as a: New Septic Line located within Homeowne Assoc. for Queen Victoria's Grant for the following homes: 45, 47, 51, and 53 Qi By Order of Town Board Mary Drive TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the (144P4 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 +r Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: SEP-000419-2017 Tax Map No: 301.20-2-1 Permission is hereby granted to: IBS Septic For property located at: 45 47 5153 Queen Mary DR 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: Queen Victoria Grant Homeowners Assoc. Septic Disposal-Residential $0.00 Owner Address: Box A Margaret DR 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 New Septic Line located within Homeowner's Assoc.for Queen Victoria's Grant for the following homes: 45,47,51,and 53 Queen Mary Drive $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,July 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 a iration date.) Dated at the Town o Queens Mo y 17,2017 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement -----� p EnLFE nn'�~ Community Development Office 1F�y` II 'I Mw/ Town of Queensbury • 742 Bay Road • Queensbury, New York •1 Office Use Only co Vj jUI\t; ' ` ems` ,c(S 7 5�f� 4191 �._ -1 IwL. PERMIT FEE _ TAX MAP NO. f a �-� PERMIT NO. CU: rRra�c - �U3 APPROVALS: ZONING �� TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT; A PERMIT MUST BE OBTAINED BEFORE WORK BEGIN` r S. APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. V OWNER: f t� v � l� O r " t�'�� INSTALLER:(),-,C\ 0W !\ C) L ADDRESS: P . lA rc^t l7�. /LA�6RESS: LoL-Irr g��Yt� S4 �� —1706-1 j PHONE NOS. 4PHONE NOS. �� LOCATION OF INSTALLATION: Re-'k rn 3 11 ' * Lfl _ S Q-ee- /n bl e-r—, _ RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS Gallons per 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 ROLLIN STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? 1 ✓ BEDROCK/IMPERVIOUS 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[mpi] (Test to be completed by a licensed professional engineer or architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: All ir.&Vidual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). TANK SIZE: 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 TYPE: t ^ h ❑ABSORPTION FIELD(WITH NO. 2 STONE) Total length ft. Each trench 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, any permit 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. I have read thWdements; respect to this application and agree to abide by thesof the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAILSanit ry Senance. icodesCaaueensbury.net 6 �� VISIT OUR WEBSITE FOR MORE INFORMATION Signat of s Responsible Date www.gueensbury.net r r , ,-...., 3 ; • ; (— \ .0 41 Win PL TS �'pA E SEEN OR CF,SERVEf� I HAVE -�- � .r ��S,TRESS, FENCES, ETC - -- -- - SUCH AS ti�SE ' SHQ'ON TIIS QOCUIENT.I HAVE PERS - ESE. �4NT DIAGRAM: r7---____.4: NA � SIG U"" \ _ __ __ 0 \ ....--c) _ . 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