2014-157 TOWN OF QUEENSBURY
Fivo742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140157 Date Issued: Monday, May 05, 2014
This is to certify that work requested to be done as shown by Permit Number P20140157
has been completed.
Tax Map Number: 523400-308-008-0001-006-000-0000
Location: 482 SHERMAN Ave
Owner: LEROY & CAROL HARGRAVES JR
Applicant: LEROY & CAROL HARGRAVES JR
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, Gw4V2/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.
�j1 jam` TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140157 Application Number: A20140157
Tax Map No: 523400-308-008-0001-006-000-0000
Permission is hereby granted to: LEROY & CAROL HARGRAVES JR
For property located at: 482 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: LEROY & CAROL HARGRAVES JF
482 SHERMAN Ave Septic Alteration Residential
QUEENSBURY,NY 12804 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC
IVAN BELL
2 LOWER WARREN STREET
OUEENSBURY,NEW YORK
Plans&Specifications
2014-157
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, May 02,2015
(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 f Que bu r 'i y r. • . 2,2014
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
p lECEodEIN
��`. Community Development Office
Vi
a Town of Queensbury • 742 Bay Road • insttlftX ge2/ 29P1•1f
Office Use Only TOWN OF OUEENSBURY id
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TAX MAP NO. 3 t,b $ -IID PERMIT NO. l5 PERMIT FEE"
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFOREEISSUANCE OF A VALID PERMIT.
OWNER: �prc, 14lGr SC a V 2..(S INSTALLER:. ) 5�'+n1 c C`
ADDRESS: fi 0 L/ S 1.-.L€r✓h-(nI% 1V� ADDRESS: 2- I UV.' fr(\J AK Cr' 5i.
PHONE NOS- I1 Q' C6-1(.)0 �( {PHONE NOS. 1 Si— O i 1
LOCATION OF INSTALLATION: 14 uL S�e I r-Or' c' `U'R
RESIDENCE INFORMATION:
YEAR BUILT
NO. X COMPUTATION = TOTAL DAILY FLOW
B DROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older IV P- X 150 = N I\ INSTALLED?
1981-1991 X — 130 = IM I-\ SPA OR HOT TUB
1992-pn�ent X 110 = 3 -1`J INSTALLED?
PARCEL INFORMATION: 1,�
• TOPOGRAPHY: FLAT ROWJ4G STEEP SLOPE IV pi %SLOPE V R-
I SOIL NATURE: SAND ✓ (( LOAM V Gt CLAY IV W OTHER IV I 1
I GROUNDWATEE AT WHAT DEPTH? dV I AArr
I BEDROCK/IMPERVIOUS MATERIAL: AT WHAT J� As
I DOMESTIC WATER SUPLY: MUNICIPAL WELL •fr It web:water supply from any septic system absorption is: 1V k ft)
I PERCOLATION TEST: RATE IS kJ A- 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 installed in a Planning Board approved subdivision)-
TANK SIZE: 130 GALLON(MIN.SIZE IS 1.000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa or whiripool tub. e.7'/41-)
SYSTEM E: [ n
,ABSORPTION FIELD(WITH NO.2 STONE) Total length` !Z0 0 ft Each trench
p f X J u
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? I Y P Size? IV f I
0 ALTERNATIVE SYSTEM Bed or other type? l V ft
l\\ p�i
❑HOLDING TANK SYSTEM Total required capacity? IV IT Tank size? IV N Number of tanks? IV
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- y!II requirements of the Town of Queensbury QUESTIONS? CALL T61-82 55 OR EMAIL
San \ry r /// mance. L-It. codesanueensburvnet
VISIT OUR WEBSITE FOR MORE INFORMATION ORMATION
Sign. " /on ResponsibleDatewww.oueensbuntnet
Townof Qgeensbury Building & Code Enforcement tu 't b
Office No. (5181761-8256 ( t,3
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Septic Inspection Report
Inspection request received:
Name: fre g+1 cOA}�d Inspected on: 5--_ 5-_
Location: 6' ,--S } a�,n,a,,� Arrive: , _ 4,„ a.m.1p.m.
Permit No.: 1 .9- /s ) Inspector's Initials: '
Comments andlor diagram
Soil Type San Clay
Type of Water:finiciaaLla?Jell Water
Waterline separation distance ft.
Well separation distance 1,7c4} t
Other wells
Well Casing Length 50'+/- YCHj N x3 N/A
M50'to well required if NO)
Absorption Field: Total length '2 00 ft.
Length of each trench OD ft.
Depth of trenches ._C ft.
Size of Stone Z.
Seepage Pits Number
Size: /v
Stone Size:
Piping Size Type A
Building to tank J^J^J^222���'''v ��'� rt eo k-A4 - €
Tank to Distribution Box L� g
Distribution Box to Field/Pd G. -b/-2—Opening Sealed a 5N
End Cap N
Inlet/Outlet Pipes&Baffles \TY N e c -s-1-6 2 -
Manholes 12"or less below grade _Y N
[provide extension collar if Yes] Y_N
Location/Separations
Foundation to tank ft. I_ \. _(3—' .5
Foundation to absorption '2_0 ft.
Separation of Pits
Conforms as per Plot P / N
Engineer Report a As-Built v/Y N
ETU Maintenance ct provided _Y N
Location of Syste . . •roperty:
Front Left Side Right Side Middle Front Middle Rear
System Use St. 0:•
Approve.
a Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
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SHOWN ON THIS DOCUMENT I HAVE PERSONALLY
MEAZZ E DI TANCE SET FORTH ON THIS DIAGRAM. -
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SUCH AS HOUSES,WELLS,TREES, FENCES, ETC
SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY
MEAS HE DI TANCE SET FORTH ONTIO DIAGRAM., hy SIGNAT DATE jW2_
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