SEP-0733-2018 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-0733-2018 Date Issued: Wednesday, November 21, 2018
This is to certify that work requested to be done as shown by Permit Number SEP-0733-2018
has been completed.
Tax Map Number: 309.14-1-38
Location: 9 RIVER ST
Owner: Patricia Deyette
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 (1a40 4
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-0733-2018
Tax Map No: 309.14-1-38
Permission is hereby granted to: Patricia Deyette
For property located at: 9 RIVER ST
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
Type of Construction
Owner Name: Patricia Deyette Septic Disposal-Residential $0.00
Owner Address: 9 River ST 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
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,November 21, 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 Town o ueen j /�We• =.d. / • . -mber 21,2018
�dei
SIGNED BY: t \ for the Town of Queensbury.
Director of Building&Code Enforcement
"e�:, _::- Community Development Office
'- _ Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only (� a W 733 "a2Q i b ti
TAX MAP NO. �Q I,,��1��D PERMIT NO. PERMIT FEE 1 S
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WA K BE INS PPLICATIcN IS SUBJECT TO REVIEW BE ORE ISSUANCE OF A VALID PERMIT.
� �-- � I SSA �' ;L
OWNER: I\ /fir 1,_;€ 'le' j l� INSTALLER: 1 Jr'
ADDRESS: # D1 K l r t . ADDRESS: a LO IN Pr A ✓Y ('C�r ,5 , Jl V\'
PHONE NOS. L. Vs 3) — O + Hi`,
/
C� (�11� S \-- PHONE NOS. ILOCATION OF INSTALLATION: 1 J\,V`P r s
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRIN
1980 or older X 150 = INSTALLED? /ii
1981 -1991 X 130 = SPA OR HOT TUN j r
1992-present 2 110 = � L. ( INSTALLED? I VV
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLI G STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND ' AM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHA DEPTH Ik
✓ 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 it c vidual sewage disposal systems must be designed by a licensed professional engineer or
architect(unless installed in a Planning Board approved subdivision).
TANK SIZE: GALL (`I (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa or whirl of tub. a S r r'
SYSTEM T PE: nn,
f ABSORPTION FIELD (WITH NO.2 STONE) Total length 1 h� ft. Each trench 0 X ei
❑ 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, anypermit 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 the r tions with respect to this application and agree to
abide by thes requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Se a ' osal Ordinance. l I o 1 U codesaaueensburv,net
� VISIT OUR WEBSITE FOR MORE INFORMATION
Sign r r on Responsible Date www.queensbury.net
SEPTIC PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
SHO ON T C 'T I V ERSONALLY
MEA URED E :A '' I� IAG�1My C,
ileir"r\ 1(l�, V/1
SIGNA DATE
�7y 6
r: NIL
c c,
1 FILE COPY
{ { W,
n 309.14-1-38 SEP-0733-2018
it I \Per - " Mark
Deyette,
9 River St
Residential Septic Alteration
wCtiei
I TOWN OF QU
BUILDING & O D T.
Reviewed By.
Date:
Ri,et" c -A ".
t/0.3
. U
G'
• Sv: rit,...) is'•
C\1; 1� i O ll
Nov z zoo$ E 0
TOWN OF QUEENSBURY
BUILDING&CODES
�i,
,,6
AS BUILT
2 ;"
I
TIME SHEETS
NAME:
DATE
DESCRIPTION
TO:
FROM
DESCRIPTION:
TO:
FROM
DESCRIPTION:
TO:
FROM
DESCRIPTION:
TO:
FROM
DESCRIPTION:
TO:
FROM