2007-557 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
4z Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLI-ANCE
Permit Number. P20070557 Date Issued: Wednesday, January 09, 2008
This is to certify that work requested to be done as shown by Permit Number P20070557
has been completed.
Tax Map Number. 523400-301-019-0001-003-000-0000
Location: 694 SHERMAN Ave
Owner. RALPH & CAROL BRAYTON
Applicant: RALPH & CAROL BRAYTON
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 (�2)j W
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 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20070557 Application Number. A20070557
Tax Map No: 523400-301-019-0001-003-000-0000
Permission is hereby granted to: RALPH & CAROL BRAYTON
For property located at: 694 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: RALPH & CAROL BRAYTON Septic Alteration Residential
694 SHERMAN Ave
QUEENSBURY, NY 12804 Total value
Contractor or Builders Name/Address Electrical Inspection Agency
Plans &Specifications
2007-557
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, October 23,2008
(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 T of ee ry —, October 23,2007
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
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APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
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OWNER: t`-�f f (`� �t�. C
�:` INSTALLER:
ADDRESS: C- Y 01 �t ADDRESS: ? � �
PHONE NOS. r < <
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PHONE NOS.
LOCATION OF INSTALLATION: _�—"— f --Sl- l,w ti'
.........................................................................................
...i...........:.................................................................... . .... . ............................................................ RESIDENCE INFORMATION
NO.OF
YEAR BUILT BEDROOMS OMS X COMPUTATION= = TOTAL DAILY FLOW
}................................................;........................._................,...........,.........................................................................;.................................................................................. GARBAGE GRINDER
1 1980 or older 1 { X '• 150 gallon per bedroom i = 1 -, INSTALLED? /t /
..........................-..................:........... ...................k.......,...;........................................................................................................ .................-...............I...........
1 1981 -1991 I 1 X 1 130 gallon per bedroom 1 1
(............................................................................................h..........a.............,...........,...............................................;..........,.......................................................................... SPA OR HOT 7�
1 1992-present ; I X 1 110 gallon per bedroom _ INSTALLED?
k................................................!...............................................;.
...........,.............. ....................................................... .........,.............................................,............................
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PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE:SAND..Y-- LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL
(IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. )
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH (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). Add 250
gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub.
✓ SEPTIC TANK;/br? GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH✓�L FT.
✓ TOTAL SYSTEM LENGTH: C FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X FT.
✓ SIZE OF STONE TO BE USED: # 2 /DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY. GAL.
1............. ...>,,,, .,.,,.,...,.,,.,,. ...,.,...,.,..,.,,.....,.,....,.,...,.......,.,.,.,.,.,.,,,,...........,.,,..,,..,,.....,..,.,,,.,,.,..,..,,.,,.,,,,,,,,..,.,........11
............. ............ ..... . . .
(( NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN i1
4 APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. '1
li.•.............................................................. .. ........................
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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 QUESTIONS? CALL 761-8256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. :codesgaueensgury.net
VISIT OUR BSITE FOR MORE INFORMATION
www.aueensburv.net
Signature Pekson Responsible Date
Town of Queensbury ■ Community Development Office - 742 Bay Road, Queensbury, NY 12804
Septic Inspection Reels:
Office No. (518) 761-8256 Dane In pectionQueensbury Building &Code Enforcement Arrive: : a rn-,�J742 Bay Rd., Queensbury, NY 12804 Inspector's InitiNAME:LOCATION: VC �'`'' ,
RECHECK: cif
Comments and/or d1wram
Soil Type: San m
T of Wa MunidpjYVell Water
Waterline se ra istance ft.
Well separation distance ft. flb�Mi~OJT TC� �L L.
Other wells:
Absorption Field: Total length ft.
Length of each trench ft. p Rfj Ij
Depth of trenches
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank R Af
Tank to Distribution Box VA 11
Distribution Box Pit bC)p '1 ice..
Opening Sea N Partial
End Ca
In( Outlet Pipes&Baffles Y N
Location Separations
Foundation to tank
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front Rear 0 Side Right Side
Middle Fron
m
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
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Ill 41- v-e-seeff.-of- sepi-ed of--bekvel-saw evtden a of,
all Olects such as houses, wells, trees, fences, etc.,
dl.o,oin on this document. I also represent that I have
�,onally measured he list ces set forth on the diagram."
E _ 1 " al1KE DATE
TOWN OF QUE97-5-7
BUILDING &
Reviewed B
Date:
6 �
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t¢tt i have �
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AVE
,
1000 gal septic $.
tank
Contractor to remove existing septic
tank and pipe network as required
for placement of new system. Install -Shallow absorption trench
new sewer to house trap as req'd. system with(4)42 ft long
Field verify all information prior to trenches.
construction and notify Engineer of -
discrepancies.
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Map Produced by Warren CountySpabal Data Viewer-www.co.warren.ny.us/gis
data sources:parcels-Warren County Real Property Tax,2003 Tentative Roll
aerial photography-NYSOFT,flown April,2001 ro��}v- 5 kA .m td9 A�:$VC
IMPORTANT NOTICE AND DISCLAIMER
THIS MAP AND INFORMATION IS PROVIDED'AS IS'AND WARREN COUNTY MAKES NO WARRANTIES OR t vN I c t PA L W^7919)
GUARANTEES,EXPRESSED OR IMPLIED,INCLUDING WARRANTIES OF TITLE,NON-INFRINGEMENT,
MERCHANTABILITY AND THAT OF FITNESS FOR A PARTICULAR PURPOSE CONCERNING THIS MAP AND THE
INFORMATION CONTAINED HEREIN.USER ASSUMES ALL RISKS AND RESPONSIBILITY FOR DETERMINING
WHETHER THIS MAP IS SUFFICIENT FOR PURPOSES INTENDED.
VISION ENGINEERING, LLC Perc Test#1 (PT1)-4 min 33 sec
4 Glens Falls Technical Park,Box#3 Deep Test Hole(TH1) 0 1020 40 60 80
Glens Falls,NY 12801 0-6 topsoil Feet
Phone:(518)792-9264 Fax:(518)792-9282 6-36 pale brn fine sand "= 5D Ift
dyron@visionengineering.org 36-72 orng brn fine sand w/loam .CtE DOG#4 �Foe_5SPTC
Groundwater @ 52", mottling @ 38" De sty4 focas