2011-546 iA TOWN OFQ UEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110546 Date Issued: Friday, October 19, 2012
This is to certify that work requested to be done as shown by Permit Number P20110546
has been completed.
Tax Map Number: 523400-308-008-0002-068-000-0000
Location: 467 SHERMAN Ave
Owner: MATTHEW J TREMBLAY
Applicant: MATTHEW J TREMBLAY
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 .. f
Director of Building&Code nforc- ent
Planning Board or Zoning Board of Appeals.
ilaki TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
ViTO
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20110546 Application Number: A20110546
Tax Map No: 523400-308-008-0002-068-000-0000
Permission is hereby granted to: MATTHEW J TREMBLAY
For property located at: 467 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: MATTHEW J TREMBLAY
29 STONEHURST Dr Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2011-546
septic alteration residential
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, October 31,2012
(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 th o f Que sb, y; / Monday, October 31,2011
SIGNED BY uv • /Y i;C
for the Town ofQueensbury.
Director of Building&Code Enforcement
OilCommunity Development Office
- Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only -
TAX MAP NO. 30g--k--2-6 .
PERMIT NO.__1L-5:43PERMIT FE. I ) _ av ?____
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PER IT MUST BE OBTAINED
BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW B ORE ISSUANCE F A VALI ERMIT.
OWNER: IA k-Trii,2C ) 72.4 14..4 INSTALLER: � Li1/ / L GIJZ..L Zt Com,
ADDRESS: Z? ‹.57,U_p A ,2. '/ ( /'PAW- ADDRESS: 1Q z -?.0 -221 6 F.
PHONE NOS. 2 ® ""/ t/ PHONE NOS. -7 9 6 O F Se.)
LOCATION OF INSTALLATION:'f cji 7 CJpf2 'L. C Q-.2 4
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT BED OOMS X (Gallons per bedroom) = TOTAL DAILY FLOW GARBAGE GRINpF,L2
1980 or older X 150 = 628 INSTALLED? �l J<J
1981-1991 X 130 = SPA OR HOT TUB, �,^
1992-present x 110 = INSTALLED? (ll'!
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLINGSTEEPSLOPE %SLOPE
I SOIL NATURE: SAND ‘/ LOAM CLAY OTHER
I 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)
I PERCOLATION TEST: RATE IS _ PER MINUTE PER INCH[mph] (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).
�x,ar�6
TANK SIZE:�o_C7 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.
SYSTEM TYPE: s
ABSORPTION FIELD(WITH NO.2 STONE) Total length O ft. Each trench 2 XO
❑SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size? _
0 ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity? _Tank size? Number of tanks?
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.
read a- .. - 'ons with respect to this application and agree to
bid y the - • d,. eq ents of the Town of ueen ury QUESTIONS? CALL 761-8256 OR EMAIL
a •
•ry S.euw 'a •pos dinance. rD �J� l' codesr7a queensbury.net
ig`ature of •erson Responsible f Dates VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
(/1:30 ) f0— / 2 7-1.e .167.
Septic Inspection Report
Office No. (518)761-8256 Date Ins•-•i••n • - - -•-• ed:
Queensbury Building&Code Enforcement Arrive: = '- rt: W�T�
742 Bay Rd., Queensbury, NY 12804 Inspector's In • . . 4,, .
NAME: TA-4i-c-wcIT NO.:
LOCATION: f�✓e spEcT ON: Mr—
RECHECK:
Comments and/or diagram
Soil Ty.-. Sa • -•-
Type of Wa -. •:. _• A - ' - _ � 3V'
Waterline separation distance "deft.
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 ft.
Length of each trench Alas ft.
Depth of trenches ft.
Size of Stone - v
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed:
End Cap N
Inlet/Outlet Pipes&Baffles ,_,N
Manholes 12"or less below grade _Y_
[provide extension collar if Yes] Y N
Location/Separations
Foundation to tank eft.
Foundation to absorption /4 ft.
Separation of Pits / ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y_N
ETU Maintenance Contract +Y— N
provided
Location of System on Property:
Front R-. Left Side Right Side Middle Fro Middle Rear
st-m
Approved
Partial Approved and needs to be re-Inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whiting\2010\Buiiding Codes Fonns\Inspecdon Fomrs\Septic Inspection Repa#_03 29 10.doc
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Community Development Office
Town of Queensbury• 742 Bay Road • Queensbury, New York •12804
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