2013-092 ��` TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130092 Date Issued: Friday, March 22, 2013
This is to certify that work requested to be done as shown by Permit Number P20130092
has been completed.
Tax Map Number: 523400-308-008-0001-035-000-0000
Location: 556 SHERMAN Ave
Owner: JANE ST. ANDREWS
Applicant: JANE ST. ANDREWS
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 / ��"'
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
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742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
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Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20130092 Application Number: A20130092
Tax Map No: 523400-308-008-0001-035-000-0000
Permission is hereby granted to: JANE ST. ANDREWS
For property located at: 556 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: JANE ST. ANDREWS Septic Alteration Residential
202 FULLER Rd Total value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY_NY 12804
Plans& Specifications
2013-092
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,March 12,2014
(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 uee bury;
e• iy arch 12 2013
SIGNED BY -I- for the Town of Queensbury.
Director of Building&Code Enforcement
r Community Development Office
5 Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 MAR 12 2013
Office Use Only
I/O ce,
TAX MAP NO.c.30I{ 3_
D g , V+35 PERMIT NO. b9-k PERMIT FEE
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS. APPLICATION
IISSUBJECT TO REVIEW BEFFORE ISSUANCE OF A VALID PERMIT.
OWNER: (1�-�r 1,1 Ler
1. / 1 e- C!I (1°00 INSTALLER: `*-6 S I e --tiC
ADDRESS: 5-515 t``'jj`er/r'-j Gn I V-e ADDRESS: I v7Q[LA/Yei' VV Or-r-P,--J `-
PHONE NOS. J W .322 1 l fl PHONE NOS. /0 -U'941
LOCATION OF INSTALLATION: ) 5n
� err\ \-G.,.. rrk./-f'
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDS
1980 or older X 150 = INSTALLED? IV� }
1981 -1991 X 130 = 5--)-0 SPA OR HOT TI4Q
1992-present X 110 = INSTALLED? Iv
PARCEL INFORMATION: / /
✓ TOPOGRAPHY: FLAT ROLLI t. STEEP SLOPE `
I`� %SLOP(EI/(U
✓ SOIL NATURE: SAND LOAM lV ]\- CLAY f[/A- OTHER
✓ GROUNDWATER: AT WHAT DEPTH? IV It-
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHA DEPTH?V f
✓ DOMESTIC WATER SUPLY: MUNICIPAL( WELL LV I I (If well:water supply from any septic system absorption is: ft)
}
✓ PERCOLATION TEST: RATE IS IV I 1 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(unless installed in a Planning Board approved subdivision).
TANK SIZE: \Ocl0 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. , y_-,15i-(7.
SYSTEM TY E; _n t
BSORPTION FIELD (WITH NO. 2 STONE) Total length /5pp 0 ft. Each trench 11 X 0
0 SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? IV Size? 1V it
❑ALTERNATIVE SYSTEM Bed or other type? I
0 HOLDING TANK SYSTEM Total required capacity? V Tank size? IV L+- Number of tanks?I V
4
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 the e ands -quirements of the Town of Queens, ury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Org- ".• :pose!Ordinance. 3-] v( codes(aqueensbury.net
VISIT OUR WEBSITE FOR MORE INFORMATION
Signat r- o' 'erson Responsible Date I
www.queensbury.net
(A, „a --stf (3)
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/ m rt:' am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: . #I' e W' PERMIT NO.: • 3'0 9a.
LOCATION: .5-Co INSPECT ON:
RECHECK:
� Comments and/or diagram
Soil Type: an Loam/ Clay
Type of Water: Municipal / Well Water
Waterline separation distance
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 'G') 1 ft
Length of each trench ft.
Depth of trenches ft.
Size of Stone fa
Seepage Pits: Number
Size:
Stone Size:
Piping Size Type
Building to tank cS� �
Tank to Distribution Box r
Distribution Box to Field/ Pit `( -C./(_,L4 ---
2-0 - M-17y-
Opening Sealed: .7 -C./(_,L4T N
End Cap N
Inlet/Outlet Pipes &Baffles .4' N
Manholes 12"or less below grade �_ N
[provide extension collar if Yes] N
Location / Separations
Foundation to tank LD1 ft.
Foundation to absorption C ft.
Separation of Pits ft.
Conforms as per Plot P
Engineer Report and -B ' Y N
ETU Maintenance C tract _Y_ N
provided
Location of System,pw roperty:
Front 'e• Left Side Right Side Middle Front Middle Rear
S stem Use Sta •s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
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