2012-335 TOWN OF QUEENSBURY
F •
742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120335 Date Issued: Monday, October 21, 2013
This is to certify that work requested to be done as shown by Permit Number P20120335
has been completed.
Tax Map Number: 523400-301-017-0001-065-000-0000
Location: 899 SHERMAN Ave
Owner: BRYAN E HAAS
Applicant: BRYAN E HAAS
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 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& ode En orcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
-0164w
"` 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120335 Application Number: A20120335
Tax Map No: 523400-301-017-0001-065-000-0000
Permission is hereby granted to: BRYAN E HAAS
For property located at: 899 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. Type of Construction Value
Owner Address: BRYAN E HAAS Septic Alteration Residential
899 SHERMAN Ave Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
BRADLEYS SEPTIC
654-6318
47 HACK Rd
CORINTH,NY 12822-0000
Plans&Specifications
2012-335
Septic Alteration Residential
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,July 16, 2013
(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 u sbury AMo •ay/J 16,2012
SIGNED BY 11 .' for the Town of Queensbury.
Director of Building&Code Enforcement
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 JUL i 1 2012
Office Use Only r
TAX MAP NO.3 0), 1 �1 - 1-fes 5 PERMIT NO. .—335 PERMIT FEE
APPROVALS: ZONING TOWN CLER
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE RK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A V,LID PERMIT.
OWNER: t IC, tINSTALLER: ,i e....
OWNER:
/ 5,,, l E,c/YYLfXiG . C2.4A. ADDRESS: /� r g‘'' [ ;�,_ __ •
(Q
PHONE NOS. PHONE NOS. 5 LI— 6�3 1 k ` 1
LOCATION OF INSTALLATION: �q 'YT E `��E_�,,AAivl�N V
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older '3 X 150 = L/sC) INSTALLED? N
1981 -1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED? NO
PARCEL INFORMATION: /
✓ TOPOGRAPHY: FLAT ROLLING V STEEP SLOPE %SLOP
✓ SOIL NATURE: SAND I✓ LOAM CLAY OTHER
n'91
✓ GROUNDWATER: AT WHAT DEPTH? / {�(�/�.e _ S Y
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
r
✓ DOMESTIC WATER SUPLY: MUNICIPAL fr WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS / ---'6.— PER MIINUTE PER INCH[mpi] (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(unlls nstalled in a Planning Board approved subdivision).
X•-
TANK SIZE:( UU GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa or whirlpol tub.
SYSTEM TYPE:
I ui
0 ABSORPTION FIELD(WITH NO.2 STONE) Total length c�t ft. Each trench 7 2c Z
51a \Ie_AV
❑S PAGE PIT(S)(WITH NO. 3 STONE) How many? Size?
ALTERNATIVE SYSTEM Bed •r other type? ELVEI6 1 t DR ell 16 6 E,
❑ 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,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 these and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
S €i� =�'G'isposal duce. codes(a.queensburv.net
'�%'�-" � ?— VISIT OUR WEBSITE FOR MORE INFORMATION
natur• of Person Res on le Datle l
9 Respon www.queensbury.net
Septic Inspection Report
Office No. (518) 761-8256 Date Inspectlo .
Queensbury Building &Code Enforcement Arrive: Ili't' /p D:.•.rt: t LZi 7C—a ftifib
742 Bay Rd., Queensbury, NY 12804 Inspector's Inid.'
NAME: NA- P'RMIT NO.:
LOCATION: JI Pt' 1 L {� INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type* •�� 11:� •m/Clay
Type of Wate Munia�. ell Water
Water - . . ion distance Cs) ft.
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 ft.
Length of each trench ft.
Depth of trenches 'W"ft.
Size of Stone 009>
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank Lc` T-1
Tank to Distribution Box _ Uj F) 37
Distribution Box to Field/ Pit � '
Opening Sealed: _ LIN' 9 ``
Ve
End Cap N _
Inlet/Outlet Pipes&Baffles N �I NI
Manholes 12"or less below grade _N
[provide extension collar if Yes] N
Location/ Separations
Foundation to tank 1D _ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N CANktkC.- 1
Engineer Report and As-Built Y N V V\j`'-g
ETU Maintenance Contract _Y N
provided
Location of System on Property:
Front Re r Left Side Right Side Middle Front�ivliddie Rear
S stem Use Sta s:
Approved
Partial Approved and needs to be re-Inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Reporl`03 29 10.doc
Septic Inspection Report
Office No. (518) 761-8256 Date Inspectio requ- " .:
Queensbury Building &Code Enforcement Arrive: Zr am( J•- rt:---r-3 -CSO a J
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:.' ' - 7 ,
NAME: Aq'T_kivi. P�'MIT NO.: C_—
LOCATION: g ����}� FI /SPECT ON: -7 — 1 3 —1
RECHECK: \-- .JT
Comments and/or diagram
Soil Type: Sand/ Loam / Clay
Type of Water: Municipal / Well Water
Waterline separation distance ft.
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 ft.
\ v__ \ � \ -Th
Length of each trench ft.
Depth of trenches ft.
Size of Stone \-?--\ V' k b a V y(_—ljR j
Seepage Pits: Number
Size: x \K- °V D , .i -\-- ! -`cWK.ttj
Stone Size:
- - \)F' --\V \Eic7 C� p _AN\
Piping Size Type •
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: Y N
End Cap _Y_ N
Inlet/Outlet Pipes& Baffles _Y N
Manholes 12"or less below grade _Y N
[provide extension collar if Yes] Y_N
Location / Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan _Y N
Engineer Report and As-Built _Y_ N
ETU Maintenance Contract _Y N
provided
Location of System on Property:
Front Rear Left Side Right Side `M`iddle Front Middle Rear
` J
S stern Use Status:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
V Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report 03 29 10.doc
, ,
b.(' - "I have seen or observed, or believe I saw evidence of,
�; �� all objects such as houses, wells, trees, fences, etc.,
shown on this document. I also represent that I have
st,i'il ed the nisynces set forth on the diagram."
TOWN OF QUEr /1 /�. •
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BUILDING & Co B 3 •; 'P-' 1 �O
�, ,,.,c. DATE
Reviewed By: , ,W�// -
Date: t 41;
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ABSORPTION BED
CROSS SECTION
SUITABLE BACKFILL
PLUS A MIN.4"TOPSOIL&SEED
•
8%MAX.SLOPE — ----— \
4"PERF.PIPE GEO TEXTILE COVER FABRIC
10-17"
30"MAX. _ —�•
/7/./A
":4!"4 �` 5. `°�S�T ..«.4�E� T f,„: ,Y �i' r , C, .�' yy¢ `�r fx
tL���x. Qa4� �� f� ': • ; siy 6"MIN.
_ �ri%ig't � s 4 ', si - `ra+ 'a3� Y . s. r r .. ';T}3 tsa
12" 1 f 24 12 1
CONCRETE SAND
2'MIN.TO IMPERVIOUS STRATA,BEDROCK
OR SEASONBAL HIGH GROUND WATER
USABLE SOIL PERCOLATION RATE 1 -30 MIN./IN.
PG 12 / FIG. 5