2015-317 .4101fti TOWN OF QUEENSBURY
wiwo 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150317 Date Issued: Thursday, July 23, 2015
This is to certify that work requested to be done as shown by Permit Number P20150317
has been completed.
Tax Map Number: 523400-309-013-0001-018-000-0000
Location: 35 OHIO Ave
Owner: JERRY A SHERLOCK
Applicant: JERRY A SHERLOCK
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 ( J
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property owner of the responsibility for compliance with Site Plan, �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.
TOWN OF QUEENSBURY
f.�
` N 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150317 Application Number: A20150317
Tax Map No: 523400-309-013-0001-018-000-0000
Permission is hereby granted to: JERRY A SHERLOCK
For property located at: 35 OHIO 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: JERRY A SHERLOCK
35 OHIO Ave Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY.NY 12804
Plans&Specifications
2015-317
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,July 20,2016
(If a longer period is required,an ap• 'cation for an -xt- sion must be made to the code Enforcement Officer
of the Town of Que> .• before exp. atio d te.
14
Dated at the To' n o s ,. ,u o y,July 20,2015
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
i _
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Community i 'i opt7ten f $9
Town of Queensbury n 742 Bay Road = Queensbury, New York .12804 JUL 2 ZU15
Office Use Only
TAX MAP NO. '?)Oci. ‘5-1 -IP) PERMIT NO. 2.1:A7- \r-4. PERMIT FEE 10 - 1 - 't
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW IR()
ISSUANCE O A VALID PERMIT.
7-c)rr ( f.)(1 INSTAL 1 FR: -_LP J J 1 1 i l-1 roar'
OWNER. �(S� C' ' .�p � \Ahl ADDRESS: � _Ok a �� ` ADDRESS: TL 1-- N f c vv l r�Qr`LA
PHONE NOS. l a '8)0) PHONE NOS. 9(-3--0 i I
LOCATION OF INSTALLATION:!!! ' 0 Pr
1 0 N\-�/e
RESIDENCE INFORMATION:
NO. COMPUTATION _ TOTAL DAILY FLOW
YEAR BUILT BEDROOMS X (Gallons per bedroom) _(-))\ GARBAGE GRINDER
1980 or older ( 1 X 150 = IC INSTALLED?
1981-1991 I X — 130 = SPA OR HOT TUB
1992-present I X 110 = INSTALLED?
PARCEL INFORMATION: `p
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE\V b %SLOP�EV 1� }�r
✓ SOIL NATURE: SAND LOAM NCLAY�V N OTHER IV 1-\--
v
✓ GROUNDWATER: AT WHAT DEPTH? V i
✓ BEDROCK/IMPERVIOUS MATERIAL- AT WHAT DEPTH? {�-I '
I
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL\\i' lk (If well:water supply from any septic system absorption is: \\1 1-\1- ft)
. V PERCOLATION TEST: RATE IS I\1 PER MINUTE PER INCH(mph (Test to be completed by a licensed professional
engineer or architect) U
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: 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:
❑/ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench` a` X
[/SEEPAGE PIT(S)(WITH NO.3 STONE) How many? \\r Size? cc� J
1�
ID ALTERNATIVE SYSTEM Bed or: other type? I\'
o HOLDING TANK SYSTEM Total required capacity? ..NI Tank size? 1\r N Number of tanks?0_
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 : - -quirements of the Town of Queensbury / QUESTIONS? CALL 761-8256 OR EMAIL
S�
Sanitary (•�I +•sal Ordinance. ---)--)-0-11)-
,J ( codesla cueensburv.net
-- I VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of •erson Responsible Date www.oueensburv.net
f Queensbury Building & Code Enforcement °� ?- l0
. (518) 761-8256
Septic Inspection Report
aft(
-741/,)-51 kr
Inspection request received: -7/�i
(3.,,,
, .
5 �bier�UC Inspected on: C.� . _7 /?-e9 I_S
Name: // 1 c P'AOL:.
�� w ,�
Location: % 6 -1 1 D c�'O L Arrive: 1 1 ,m,
Permit No.: l c Inspector's Initials: ^'`
• ments and/or dia•ram
Soil Typ . Sa ..m r ay
Type o - . Munic'•- f ell Water ,ct _-15
Waterline s:•- . '•n distance ft. f��R — ��
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
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number r
Size: 67 x
Stone Size: A`
Piping Size Type
Building to tank LA" liG k-VC
Tank to Sistgr'on
D.:. oris• :`',.•. Pit v GJ V Q—"72
Opening Sealed: e,/Y_
End Cap Y N
Inlet/Outlet Pipes&Baffles
Manholes 12"or less below grade _N
[provide extension collar if Yes] _Y
Location/Separations l
Foundation to tank ‘15-46 ft.
Foundation to absorption '2ft. `� ��� ���� �`��
b
Separation of Pits ft. 17F , ,
Conforms as per Plot Plan _Y__N
Engineer Report and As-Built _Y_N
ETU Maintenance Contract provided Y_N
Location of System on Property: ',
Front Re Left Side Right Side Middle Front Middle Rear
System Use Sta s:
Approved .
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
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