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SEP-0746-2018 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518) 761-8201 Yry'u G" 4 Community Development - Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number: SEP-0746-2018 Tax Map No: 302.14-2-37 Permission is hereby granted to: IBS Septic For property located at: 20 NORTHUP 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 Type of Construction Owner Name: Bob Bradley Septic Disposal-Residential $0.00 Owner Address: 20 Northup 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 Deep Hole/Perc Test Septic Alteration $ 200.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Monday, May 4, 2020 (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 of Queensbury; Friday, May 3, 2019 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement SEPTIC DISPOSAL PERMIT Ali- ' Cw I' U I V L -' • s - . Onl 5eP-'O2-44Q- zoit r 742 Bay Road,Queensbury,NY 1.8 1' J- �C�Tvw.n of(�uecnsdsan- P:518-761-8256 www.queensb •t '"Tax Map ID#: g b�- �- -3 7 MAY 02 20 i F se: $ ; Invoice#: 1 VW 1 (� IV w N OF QUEENS Va,lance. Yes No Project Location: d- \J ®�'� k _ • *`' P ' Primary Owners) &\f) 3(- ,\,, Mailing Address 4) ç\ pr 7 U P Phone & Email P Installer/Builder t S e ; ,,, Mailing Address 2 0 VV G r Phone & Email S.L6 ._) 9 __..I 9tf Engineer E4N4 C Mailing Address 0 4 fl`1 Nkt — ,P,n.Y tk Phone & Email I.)a--°'14 is©).— _1 Contact Person for Building&Code Compliance: C r6,) .' It Phone: 'c1 P)t ) '6`3 RESIDENCE INFORMATION: Year Built Gallons #of bedrooms X gallons per =total daily flow per day bedroom Garbage Grinder Yes No 77 1980 or older 150 Installed? (circle one) /` 1981-1991 130 Spa or Hot Tub Yes Nam' 3 / 3 n Installed? (circle one) 1992-Present 110 II ( J PARCEL INFORMATION: Topography at Rolling Steep Slope %Slope Soil Nature - ' Sand Loam Clay Other Groundwater At what dep1h1? _ Bedrock/Impervious material At wha epth? Domestic Water Supply unicipal _Well (if well,water supply from any septic system absorption is—ft.) Percolation Test Rate: per minute per inch (test to be completed by licensed engineer/architect) _PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size ,1( I i- (min. size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub System Absorption field with#2 stone Total length () ft.; Each Trench 1 () 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. j' , 1_, _ PRINT NAME: if DATE: L _J SIGNATURE: DATE: 5 7 i Town of Queensbury Building&Code orcement / V Revised March 2018 ,i p S7tkriff Town of Queensbury• Building&Codes Enforcement Office■742 Bay Road• Queensbury,NY 12804 DEEP HOLE/PERC TEST Request for Town Engineer Review Property Owner: ?7O ) �„ Phone: �7-- I 111 - 3(1*3 Property Owner's 2n rA Address: t I� � 1 .V D 1 V �f r Location of Test: Tax ID#: O2(t4 — 2-37- *Applicant's Engineer: F-)C 1 N K 1 1,L. RV 1{ ti I .e L':e/a Phone: t)` /-1 I - 020 Applicant's Agent: IN CA ni se414itAlL .(, i- 1 T:O T( -E Phone: 6(B 141 '" 0 2{ -, Additional Notes: 1. Reason for Request? New Septic System Replacement Septic System Failed Septic System Subdivision Site Plan Review rt�a F a l!J .. 2.Are Wetlands present? YES NO UNKNOWN NOV 27 2C18 *Note: Applicant is required to engage an engineer for design and testing of the syrste The Town Engineer's responsibility is to witness system testing only. TOWN OF iRY COMMUP" ''fiENT PLOT PLAN: Plot plan, to scale, to be submitted with application FEE SCHEDULE: a. $ 200 Flat Fee Date Paid: II >7 /( Check No.: b. OR Fee to be determined during To Be Determined: Site Plan !Subdivision review process SIGNATURE: In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may engage the services of a qualified professional consultant for expert review and recommendation arising from the carrying out of the provisions of Art. IV, including but not limited to the review of plans, specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep hole and percolation tests, system installations, and any other aspect of any matter contained in this Art. IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an invoice for same, whichever is sooner. Such costs shall not exceed $1,500 without prior written notice to the party to be charged with same. My signature below indicates I have thoroughly read and understand the instructions, agree to the submission requirements and have completed the application. I also fully understand that additional engineering fees may be necessary per Town of Queensbury Local Law 136-14D. SIGNATURE OF APPLICANT: 4Qg Date: SIGNATURE OF AGENT: Date: d✓2li � N , t Original (B&C File) Canary (Planning) Pink(Applicant) Gold (Town Clerk) Chazen Engineering, Land Surveying & Landscape Architecture Co., P.C. Chazen Environmental Services, Inc. The Chazen Companies, Inc. RUCINSKI HALL ARCHITECTURE �N�N� Ronald Richard Rucinski �♦ ,�J Ethan Peter Hall G♦���G 134 Dix Avenue �`� 0 Glens Falls NY 12801 P Voice 518 741 0268 Fax 518 741 0274 Email ephall@nycap.rr.com Bradley Residence- Northup Drive 6 May 2019 John O'Brien —Town of Queensbury Building Department 742 Bay Road Queensbury NY 12804 Re: Installation of Replacement Sewage Disposal System At the above referenced project location this office observed the installation of the new gravity laterals, distribution box and piping from existing septic tank. The concrete tank was verified to be in working order and the existing water line was located on the drawing. These installations are acceptable to this office. If there are any questions please contact our office to discuss. Regards, "' -.; ,,4 1,, Ethan Peter Hall t ' Architect i CEOWEO MAY 062019 AS BUILT r TOWN OF QUEENSBURY BUILDING&CODES Y:\!Mac\Septic Letters\Septic Letter-Queensbury-Bradley Residence-6 May 2019.doc 1