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SEP-0789-2018 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-0789-2018Date Issued: Friday, December 21, 2018 This is to certify that work requested to be done as shown by Permit Number SEP-0789-2018 has been completed. 301.13-2-22 Tax Map Number: 4 TREEHOUSE LN Location: Ross Dubarry Owner: IBS Septic Applicant: 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 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 ri 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: SEP-0789-2018 Tax Map No: 301.13-2-22 Permission is hereby granted to: IBS Septic For property located at: 4 TREEHOUSE 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 Type of Construction Owner Name: Ross Dubarry Septic Disposal-Residential $0.00 Owner Address: 4 Treehouse LN 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: Friday, December 13, 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 ury; drur . y if)-•= ber 13,2018 SIGNED BY: lir \ for the Town of Queensbury. Director of Building&Code Enforcement DEC 12 2018 g 1 � :; Community Development Office _ y.'+ 4 Town of Queensbury • 742 Bay Road • Queensbu iiv d 1 , OSBURY OOMMUNITY DE-,•FLOPMENT Office Use Only ��� -78 y_� Q / g- TAX MAP NO. �3c'' 3 °a PERMIT NO. PERMIT FEE /'vsvJ,ce 1 I( 9 APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BBEF IS.SUA)CE OF A VALID PERMIT. OWNER: r `�S ? INSTALLER: 15 5 J� 0 IL ADDRESS: 4- Tr (� '� ►'`Q GL.1 �-/%. ADDRESS: �, LO 'PC4Cct(k\ 5±. Qb . tt rk) q - I _ PHONE NOS. � � �fi � 'J '��J PHONE NOS. � U �� 0 LOCATION OF INSTALLATION: Tre ri e Cif 61.(ci_ , RESIDENCE INFORMATION: NO.OF COMPUTATION YEAR BUILT X = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRI D 1980 or older X 150 = INSTALLED? 1981 -1991 X 130 = SPA OR HOT TU � p 1992-present X 110 = �� INSTALLED? V /Th 7 PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLI I STEEP SLOPE %SLOPE / SOIL NATURE: SAND LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? / 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[mpg (Test to be completed by a licensed professional engineer or architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed professional engineer or architect(unless install in a Planning Board approved subdivision). � �j� TANK SIZE: MLLON (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 TY E: 0ABSORPTION FIELD(WITH NO. 2 STONE) Total length� O 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,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 regulations with respect to this application and agree to abide by ese and all req rements of the Town of Queensb QUESTIONS? CALL 761-8256 OR EMAIL S ai a Disxs rdinance. \ k,f)--et codes @Aueensburv.net VISIT OUR WEBSITE FOR MORE INFORMATION Signs ur Pp on Responsible Date www.queensburv.net INSPECTION WORKSHEET (SEP-008954-2018) Town of Queensbury - Building and Codes - Fire Marshal 742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal SEP-0789-2018Permit Case Number:Case Module: Thu Dec 20, 2018Passed Inspection Date:Inspection Status: John O'BrienSeptic Inspector:Inspection Type: 4 TREEHOUSE LN301.13-2-22 Job Address:Parcel Number: Queensbury, NY 12804 Contact TypeCompany NameName Granted PermissionIBS Septic Primary OwnerDubarry, Ross ApplicantIBS Septic ContractorIBS Septic Checklist ItemPassedComments Building Inspector NotesYES12/20/18 Septic System Approved As-Built Received Type of Water: Municipal / Well WaterYESMunicipal Absorbtion Fields: Total LengthYES250' Length of Each TrenchYES5@50' Depth of TrenchesYES24" - 30" Size of StoneYES#2 Building to TankYESExisting Dec 20, 2018Page (1) INSPECTION WORKSHEET (SEP-008954-2018) Checklist ItemPassedComments Tank to Distribution BoxYES4" sdr35 pvc Distribution box to Field / PitYES4" sdr35 pvc to 4" sdr35 pvc perforated Foundation to TankYESExisting 10' + Foundation to AbsorptionYES50'+ Engineer Report and As-BuiltYESAs-Built Received System Use StatusYES12/20/18 Septic System Approved As-Built Received O'Brien, John (Inspector) Dec 20, 2018Page (2) 301.13-2-22 SEP-0789-2018 Dubarry, Ross 4 Treehouse Ln SEPTIC PLOT �.. 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