BOTH-000118-2016 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: BOTH-000118-2016 Date Issued: Wednesday, April 27, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000118-2016
has been completed.
Tax Map Number: 309.5-1-35
Location: 401 SHERMAN AVE
Owner: Elizabeth Dunkley
Applicant: Elizabeth Dunkley
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEEENSBUURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, GGG VVV
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: BOTH-0001 1 8-201 6
Tax Map No: 309.5-1-35
Permission is hereby granted to: Sanitary Sewer Service
For property located at: 401 SHERMAN 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
jyW of Construction
Owner Name: Elizabeth Dunkley Septic Disposal $0,00
Owner Address: 401 SHERMAN AVE Total Value 50.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Sanitary Sewer Service
PO Box 224
Glens Falls,NY 12801
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,March 3,2017
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date,)
Dated at the Town or7j �fue T ,2016
SIGNED BY: �vJ for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT Office Use Ogly_
yf DQE J/ U Received
Tax Map ID
TA]C IUTAP ID Permit No. 51-x-I t$ 20 t \c
n �� f d/ f Permit Fee 071 V 5
LocAycm OF1NsrALLA77oN 6,4Jc f/��i r Approvals:
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ADDRESS Vol
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ADDRESS;
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®fArJUER l 2;�J�L ` (,�K• PHDNEJE-Am&
Address U/ 9-e-!-M - -�
CONTACT PERSON FOR 9MALDINO&CODES COMPLIANCE. `'�Qr �l PHONE
PES1t9gNCg� RORAl1Q7/0N
Year Built #of bedrooms X Gallons per bedroom =Total Daily Plow
1980 or older Garbage grinder installed Y �.Z N
1981-199t s-v rr5 v Spa or Hot Tub installed —Y —N
T992-PresenT
PARCEL lNFl1RM6iT1[�
`topography Plat roiling Steep slope %slope
Soil Mature Sand Loam Ciay other
Groundwater At what depth?
Bedrock/Impervious Material At what depth?
Domestic Water Supply Municipal 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 engineering I architect)
PROECSED SYSTEM FOR MEW CONSTRUCTION
Tank Size gallons(minimum size 7,000 gallons,acid 250 gallons to size for each garbage grinder or spa or hot tub)
Systom Type ,absorption field with 42 stone Total length Z C ' ' fit.,Each trench S
Seepage Pit with#3 stone How many: /�-A-- =size
Alternative System Bed or other type?
Holding Tank System Total required capacity? UT'J�" Tank size ottanks
otes: 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-Bulit plan is received&approved. The installed system must match the septtc system
layout on file–no exceptions.
DwLANA-7ox. 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 know by or on behalf of an applicant, shall be void. I have read the regulations
and agree to ablde by�ese and all pquirernents of the Town of Queemsbury Sanitary sewage D[opoaal Ordinance.
Print Name: !r, pre-1(D S Date:
Signature:
-- Date:
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
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