SEP-0262-2018 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-0262-2018 Date Issued: Monday, May 21, 2018
This is to certify that work requested to be done as shown by Permit Number SEP-0262-2018
has been completed.
Tax Map Number: 308.5-1-56
Location: 79 LAUREL LN
Owner: Patricia Fitzgerald
Applicant: IBS Septic
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the �f
property owner of the responsibility for compliance with Site Plan, �Q
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-0262-2018
Tax Map No: 308.5-1-56
Permission is hereby granted to: IBS Septic
For property located at: 79 LAUREL 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: Patricia Fitzgerald Septic Disposal-Residential $0.00
Owner Address: 79 Laurel LN Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name I Address Electrical Inspection Agency
IBS Septic
2 WARREN ST
Glens Falls,NY 12801
Plans& Specifications
Residential Septic Alteration
S 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday, May 17,2019
(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 To of Que sbury 4 T sd 17,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
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SEPTIC DISPOSAL PERM IrA1� se Onl
742 Bay Road,Queensbury,NY 1 i {
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MAY 1 6 201 t
P:518-761-8256 www.queens t
Tax Map ID#: L7�5 I vol rmit ee: $�; Invoice#: �{
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Project Location; / �] L ►ti.lr� L L BUILDING&CO Septic ariance? Yes No
Primary Owner(s) CA t G
Mailing Address CA o , L(1
Phone & Email l �' (�0
Installer/Builder S 5
Mailing Address YVV CACC
Phone & Email
Engineer
Mailing Address
Phone & Email " I /
Contact Person for Building&Code Compliance: �� Phone:
RESIDENCE INFORMATION:.
Year Built Gallons #of bedrooms X gallons per = total daily flow
per day bedroom Garbage Grinder Yes No
1980 or older 150 Installed? (circle one)
1981-1991 130 Spa or Hot Tub Yes No
Installed? (circle one)
1992-Present 1 110
PARCEL INFORMATION:
Topography ___L/flat Rolling Steep Slope %Slope
Soil Nature ___V Sand Loam Clay Other
Groundwater At 4at depth?
Bedrock/Impervious material At hat depth?
Domestic Water Supply _Municipal _Well (if well, water supply from any septic system absorption is
Percolation Test Rate: per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size , i gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length n 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: /` DATE:
SIGNATURE: DAT r �4
hy
Town of Queensbury Building&Code En Cement Revised March 2018
Pipeline Specialists JOB:
SHEET 308.5-1-56 SEP-0282-2018
iEl P4 NO,: Fitzgerald, Patricia
CALCULA- 79 Laurel Lane
Y it J. Prescott, Inc. ICALE Residential Septic Alteration
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MAY 18 2018
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