SEP-000358-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-000358-2017 Date Issued: Monday, July 24, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000358-2017
has been completed.
Tax Map Number: 308.8-1-5
Location: 474 SHERMAN AVE
Owner: Daniel Abell
Applicant: Daniel Abell
This structure may be occupied as a: Residential Septic Alteration
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
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
QL Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000358-2017
Tax Map No: 308.8-1-5
Permission is hereby granted to: The Country Plumber
For property located at: 474 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
Tvce of Construction
Owner Name: Daniel Abell Septic Disposal-Residential $0.00
Owner Address: 474 Sherman AVE Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
The Country Plumber
23 LEO ST
Queensbury,NY 12804
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,June 22,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town ofens ;j
hurs a ,J 17
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
F
SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only
742 Bay Road,Queensbury, NY 12804
P:518-761-8256 _ Permit#:
www.gueensbury.net
Tax Map ID#: —( —5 Permit Fee:$�; Invoice#: 1��3
Project Location: 4 7 V lepb/L �3jjsi2✓rt w-rJ Septic Variance? Yes No
Primary Owner(s) £ , :,' `-
Mailing Address
Phone & Email
Installer/Builder �-yt— oe a ock r.
Mailing Address OF QUEENSBURY
COMW T
Phone & Email }r Itt,. �tufm�tL •cor+ 8 2J - o
Engineer
Mailing Address
Phone & Email
Contact Person for Building&Code Compliance: Phone:
RESIDENCE INFORMATION:
Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes I o
1980 or older Z Installed? (circle one)
1981-1991 Spa or Hot Tub Yes No
Installed? (circle one)
1992-Present
PARCEL INFORMATION:
Topography Flat Rolling _Steep Slope _%Slope
Soil Nature Sand _Loam _Clay _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 engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size I LqOa gallons(min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length (D ft.; Each Trench O ft.
Seepage Pit with#3 stone How many: ;Size:
Alternative System Bed or other type:
Holding Tank System Total required capacity? :tank size ;#of tanks
NOTES: 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-built plan is received and approved.
The installed system must match the septic layout on file—no exceptions.
Declaration: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 known by or on behalf of an applicant,shall be void. I
have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage
Disposal Ordinance.
PRINT NAME: ��7�oC� DATE:
SIGNATURE: c=?-5'�/7/� CL% ' `- DATE: LZZ-1-7
Town of Queensbury Building&Code Enforcement Revised February 2017
MAP REFERENCE: DEED REFERENCE:
BURNT HILLS SUBDIVISION DAVID &ANTONELLA MARGISON
DKC HOLDINGS, INC. TO
DATED: JULY 23, 2001 DANIEL W. &DENISE A. ABELL
LAST REVISED: JANUARY 17, 2002 DATED MARCH 11, 2017 _
BY. VAN DUSEN& STEVES, LLC BOOK 5525 PAGE 8
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OL s MAP BEARING A LICENSED LAND SURVEYORS SEAL ISA ' e 1" ®'
UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY = Map Of a 0.7urvP.y made for
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VIOLATION OF SECTION 7209,SUB-DIVISION 2,OF THE - Daniel
NEW YORK STATE TH ON LAW.° W.
Abell
1� 'ONLY COPIES FROMOM THE ORIGINAL OF THIS SURVEY
_UMARKED WITH AN ORIGINAL OF THE LAND SURVEYORS
SEAL SHALL BE CONSIDERED TO BE VALID TRUE COPIES,"
'CERTIFICATIONS INDICATED HEREON SIGNIFY THAT - _ -
THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE
THE CODE OF PRACTICE FOR LAND SURVEYORS ADDp QED
And
BY - -
BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAU
j LAND SURVEYORS.SAID CERTIFICATIONS SHALL RUN ONL'r -NTAL ® - - _
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Abell SHEET 1 of 1
_ 7�7 v ® TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND - i /' /'� - -
NCY AND LENDING
flON LISTED
169 Haviland Road Queensbury New York 12804 TOETHE ASSIGNEES OFON HIS BEHALF TO ETHE I EINDIINGTTLE AINSTITUTIONONE AND Town of QueensburGy, 1(B�rAreII �:011n��y, I�BW York �' 3
y ABELL 6
(518) 792-8474 New York Lic. No. 50135
NO DATE DESCRIPTI1.ON Dwc No 1 11 701 7
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