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2015-317 .4101fti TOWN OF QUEENSBURY wiwo 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20150317 Date Issued: Thursday, July 23, 2015 This is to certify that work requested to be done as shown by Permit Number P20150317 has been completed. Tax Map Number: 523400-309-013-0001-018-000-0000 Location: 35 OHIO Ave Owner: JERRY A SHERLOCK Applicant: JERRY A SHERLOCK This structure may be occupied as a: Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the ( J ,g/t. property owner of the responsibility for compliance with Site Plan, �d 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 f.� ` N 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20150317 Application Number: A20150317 Tax Map No: 523400-309-013-0001-018-000-0000 Permission is hereby granted to: JERRY A SHERLOCK For property located at: 35 OHIO Ave 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 Value Owner Address: JERRY A SHERLOCK 35 OHIO Ave Septic Alteration Residential QUEENSBURY,NY 12804 Total Value Contractor or Builder's Name /Address Electrical Inspection Agency IBS SEPTIC & DRAIN ATTN: IVAN BELL 2 LOWER WARREN St OUEENSBURY.NY 12804 Plans&Specifications 2015-317 Residential Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,July 20,2016 (If a longer period is required,an ap• 'cation for an -xt- sion must be made to the code Enforcement Officer of the Town of Que> .• before exp. atio d te. 14 Dated at the To' n o s ,. ,u o y,July 20,2015 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement i _ ..1m.. Community i 'i opt7ten f $9 Town of Queensbury n 742 Bay Road = Queensbury, New York .12804 JUL 2 ZU15 Office Use Only TAX MAP NO. '?)Oci. ‘5-1 -IP) PERMIT NO. 2.1:A7- \r-4. PERMIT FEE 10 - 1 - 't APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW IR() ISSUANCE O A VALID PERMIT. 7-c)rr ( f.)(1 INSTAL 1 FR: -_LP J J 1 1 i l-1 roar' OWNER. �(S� C' ' .�p � \Ahl ADDRESS: � _Ok a �� ` ADDRESS: TL 1-- N f c vv l r�Qr`LA PHONE NOS. l a '8)0) PHONE NOS. 9(-3--0 i I LOCATION OF INSTALLATION:!!! ' 0 Pr 1 0 N\-�/e RESIDENCE INFORMATION: NO. COMPUTATION _ TOTAL DAILY FLOW YEAR BUILT BEDROOMS X (Gallons per bedroom) _(-))\ GARBAGE GRINDER 1980 or older ( 1 X 150 = IC INSTALLED? 1981-1991 I X — 130 = SPA OR HOT TUB 1992-present I X 110 = INSTALLED? PARCEL INFORMATION: `p ✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE\V b %SLOP�EV 1� }�r ✓ SOIL NATURE: SAND LOAM NCLAY�V N OTHER IV 1-\-- v ✓ GROUNDWATER: AT WHAT DEPTH? V i ✓ BEDROCK/IMPERVIOUS MATERIAL- AT WHAT DEPTH? {�-I ' I ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL\\i' lk (If well:water supply from any septic system absorption is: \\1 1-\1- ft) . V PERCOLATION TEST: RATE IS I\1 PER MINUTE PER INCH(mph (Test to be completed by a licensed professional engineer or architect) U PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual 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: ❑/ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench` a` X [/SEEPAGE PIT(S)(WITH NO.3 STONE) How many? \\r Size? cc� J 1� ID ALTERNATIVE SYSTEM Bed or: other type? I\' o HOLDING TANK SYSTEM Total required capacity? ..NI Tank size? 1\r N Number of tanks?0_ 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 the regulations with respect to this application and agree to .. `� abide by th- a : - -quirements of the Town of Queensbury / QUESTIONS? CALL 761-8256 OR EMAIL S� Sanitary (•�I +•sal Ordinance. ---)--)-0-11)- ,J ( codesla cueensburv.net -- I VISIT OUR WEBSITE FOR MORE INFORMATION Signature of •erson Responsible Date www.oueensburv.net f Queensbury Building & Code Enforcement °� ?- l0 . (518) 761-8256 Septic Inspection Report aft( -741/,)-51 kr Inspection request received: -7/�i (3.,,, , . 5 �bier�UC Inspected on: C.� . _7 /?-e9 I_S Name: // 1 c P'AOL:. �� w ,� Location: % 6 -1 1 D c�'O L Arrive: 1 1 ,m, Permit No.: l c Inspector's Initials: ^'` • ments and/or dia•ram Soil Typ . Sa ..m r ay Type o - . Munic'•- f ell Water ,ct _-15 Waterline s:•- . '•n distance ft. f��R — �� Well separation distance ft. Other wells: ft. Well Casing Length 50'+/- Y N N/A [150'to well required if NO] Absorption Field: Total length Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number r Size: 67 x Stone Size: A` Piping Size Type Building to tank LA" liG k-VC Tank to Sistgr'on D.:. oris• :`',.•. Pit v GJ V Q—"72 Opening Sealed: e,/Y_ End Cap Y N Inlet/Outlet Pipes&Baffles Manholes 12"or less below grade _N [provide extension collar if Yes] _Y Location/Separations l Foundation to tank ‘15-46 ft. Foundation to absorption '2ft. `� ��� ���� �`�� b Separation of Pits ft. 17F , , Conforms as per Plot Plan _Y__N Engineer Report and As-Built _Y_N ETU Maintenance Contract provided Y_N Location of System on Property: ', Front Re Left Side Right Side Middle Front Middle Rear System Use Sta s: Approved . Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report I I ' 1 I 1 ; ERIIIMMINIMIMININ 1 ' I , 1 1 1 11111111111EIMMEMIMIEN (,-. i 1 , 1 MINIMISTMETITINIMINIC c.„ E:. 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