2001-231 TOWN OF QUEENSBURY
BayRoad, Queensbury, 12804-5902 (518) 761-8201
vers 742 o , Qv,
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010231 Date Issued: Friday, May 04, 2001
This is to certify that work requested to be done as shown by Permit Number P20010231 •
has been completed.
Tax Map Number: 523400-309-007-0002-008-000-0000
Location: 161 SHERMAN Ave
Owner: JEFFREY GUAY
Applicant: JEFFREY GUAY
This structure may be occupied as a:
By Order of Town Board
Septic Alteration,Residential TOWN OF QUEENSBURY
Director of Building& ode -nforcement
1
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010231 Application Number: A20010231
Tax Map No: 523400-115-000-0004-017-000-0000
Permission is hereby granted to: JEFFREY GUAY
For property located at: 161 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: JEFFREY GUAY Septic Alteration Residential
161 SHERMAN Ave Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
OUEENSBURY SEWER
JAY SWEET
Plans &Specifications
/2001-231
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Sunday,May 04,2003
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbuty before the expiration date.)
Dated at the To Queens ury; Fr' y May 04,2001
SIGNED BY for the Town of Queensbury.
Director of Building Code 'nforcement
Application for Permit=Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Location of installation: S tl a Office Use
/ 6f File Permit NoC> X) /
Tax Map No. / / �'
�� r Fee Paid c-�' G
Owner's Name: \ J �r Cu a `� j
I
Address: 1(.; ( ,C4e�0 ta- )
2. INSTALLER'S NAME : a,I ci, _it,f. Ett r c) .. PHONE NO./f ,226 6
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older 7 c3 150 gal/bdrm = 44:5—° ,�::
1980— 1991 x 130 gal/bdrm = RC,FI
1991 —present x 110 gal/bdrm = AY ?
Garbage Grinder Installed yes— /0 70/4 2001
D�
Spa or Whirlpool Installed yes / isB(lIi.bii `�(1E Nsa ,
�G AND GObl Y
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
To o r h Soil Na ure Ground Water Bedrock or Impervious Material Domestic Water Supply
Fla ' war, at what depth at what depth (fnunic �
Rolling loam feet feet well
Steep slope . clay if well; water supply
_%slope other from any septic-system
depth: 1 absorption is ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. 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.
T
Septic Tank:le---e-z) gallon (min. size 1,000 gal)
Tile Field: each trench ft. Total System Length: ft.
Seepage Pit(s): number of size of each: ft by ft.
Size of Stone to be used: li -_ / depth or thickness feet
Bed System Size: x
r
Alternative System:f 171, (r -7.4 length,and/or size err) J — 5(0
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
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 Sanitary Sewage Disposal Ordinance.
\ ailk,
1QV` �— 2 — c'
t;.; • urof responsible person Date
7\ -TOWN OF QUEENSBURY
`BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location on
Date W a Permit # t;
SOIL TYPE. Sand- oam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: /
ABSORPTION FIELD : To .1 Len,tk1
Length of each trench ���'
Depth of trenche• -
Size of stone L L�'' _
SEEPAGE PITS: Nu3ber-
Size - ft. x ft.
Stone size
PIPING: Sime Type
Bldg. to Tank C
Tank to Dist. Box �=
Dist. Box to Field/Pi k L�
Openings Sealed? tip No Partial
LOCATION/SEPARATIO
Foundation to Tank. feet
Foundation to Absorption Nom feet
Separation of Pits " �� feet
Conforms as per Pl o ' an �� No
LOCATION OF SYSTEM 4.. " 'ER
(circle one)
Front - Rear - - Right ide
Middle Front - Mi •a e Rear
COMMENTS:
SYSTEM USE APPRO ED: (—/"; NO
Arrived: '
Departed: R
C-0"/
Building Inspector
•
,,
r
Vo
--
i •
/c) o
I'd aj
----4.0,1--to
d ,
3
000 /
3
I -0Z3
- ' •
a..mjitaLii07
(
r
REcFivED
)
MAY 0 3 2001
E3 TOWNinLTDOolytiNG:AiNED:ENtaffy c,r.
TMENT
. #
Based on our limitedexL I
- I
ipicioaotnmsbspaiancondncesspt.rwietie.d:flicaoaustiroincomments shalli
,
catareing fulfill-
•
...
compliance with the code
72-1 •
- "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
TOWN LiThr: QUEEN'"BU Y personally measured thepIances set forth on the diagram."
S NATURE DATE
REVIEWED B _
, -
,
DATE J or
. .
•
.
.
;
.
.
• . ....•-
„
.
, .
.
•
,..
•
•
•
.
.
5
.• ..
.
, •
..