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2012-191 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20120191 Date Issued: Monday, October 21, 2013 This is to certify that work requested to be done as shown by Permit Number P20120191 has been completed. Tax Map Number: 523400-301-019-0001-002-000-0000 Location: 688 SHERMAN Ave Owner: JOHN & TAMARA SCHROEDER Applicant: JOHN & TAMARA SCHROEDER 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 bythe pp . recto of Bui dine ol,` Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY FoN 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20120191 Application Number: A20120191 Tax Map No: 523400-301-019-0001-002-000-0000 Permission is hereby granted to: JOHN &TAMARA SCHROEDER For property located at: 688 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: JOHN& TAMARA SCHROEDER 688 SHERMAN Ave Septic Alteration Residential QUEENSBURY,NY 12804-0000 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2012 septic alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, April 24, 2013 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town fQuee bury /Tue. i .y, A s ril 24, 2012 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement ?x Community Development Office � ,1 I Ati it.A` Town of Queensbury - 742 Bay Road - QueensaRj, 3w11`a tk •1.280 Office Use Only Y ff / -2 TAX MAP NO. 30 1 . 1 9-1 `d PERMIT NO. /A-/9-/ r PERMIT FEE LIO1 1>1" APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: - 2 ZJ•` ,'2k 11 C-42 r INSTALLER: . t1-f �'-- ADDRESS: S I 1:-'(-./f�r S (1ut4rt4- ADDRESS: • 14bt.�!'y,,vL/lore`, PHONE NOS. "? 9)`0 c 74, •7 "— (U t PHONE NOS. 2S LOCATION OF INSTALLATION: & �C Peer—SA-7,14-1-4,4 40-e RESIDENCE INFORMATION: NO.OF COMPUTATION YEAR BUILT X = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINP 1980 or older 2, X 150 = 4---/ c U INSTALLED? 1981 -1991 X 130 = SPA OR HOT TU$i 1992-present X 110 = INSTALLED? 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 SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpi] (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). E5\1 , /titt/i TANK SIZE: l 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. t SYSTEM TABSORPTION FIELD (WITH NO. 2 STONE) Total length L1 �5�, �F\L\Y�(�17�� l�/ 7 l � ft. Each trench X ❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size? C 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. I he read the egulations with respect to this application and agree to abide y thes and all requir,ments of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL $anitaryitew ge(D' pos rdinance. f codes(a)queensburv.net VISIT OUR WEBSITE FOR MORE INFORMATION Signature of Person Responsible Date www.queensbury.net Community Development Office • Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 SIDE PROPERTY LINE '.&. .'r (--:.\•,- ,:._, x cam! / '---- .-", I • V, 4 , .„, _ . . ______;.,/. ,e.,,.1...,,:_,../_,•_________...... .:,7.1.,7_,,,, .7 1 ti' lg I 7::-.2."'-'::,1 l'. it z 1-1 1— fY J CY Q �W L.I.. . I Si Fri � fi (Ci3c) Septic Inspection Report Office No. (518) 761-8256 Date In •-ctio�n ,-_ e - •d: Queensbury Building &Code Enforcement Arrive:f - �' .epart: %7 am 742 Bay Rd., Queensbury, NY 12804 Inspector's I, 1r. NAME: C-1.\('D eclar " IT NO.: / �'' 19/ LOCATION: L .�� �1 Pi U'`� r� SPECT ON: E'1—� 1"/ -J Z, RECHECK: Comments and/or diagram Soil Ty•-• rr . .. ►- Cl.y Type of Wat= . Munici•-Iy4Tn",,-ter Wa - '- - -•aration distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A Absorption Field: Total length � ft. Length of each trench Depth of trenches _ _ft. Size of Stone LTP Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank t t Tank to Distribution Box Distribution Box to Field/ Pit zk 'WA\ \ L Opening Sealed: Y N End Cap Inlet/Outlet Pipes&Baffles 4 N Location/ Separations • Foundation to tank Zc ft. Foundation to absorption k . �"�-- Separation of Pits ft. Conforms as per Plot Plan YY N Engineer Report and As-Built Y N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear S stet Us- . : Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc G\ C'L:_IAA;-o--e...4-er ' 'I — 1 o j ' ( (SBoz &c _ 1 -uf. 7 f-- 0..576 (fr-) • C31 (4-e.4?-c-v-,-,-;b v.._(-y ),\j 7 g-FILf (r 4frr1-eS 7�` 1 \>S) (),-) cil•- 4 — 5 04)-f--.- . : 0-0.\\'‘' \ • \cti\Ple-- [11 1 APR 2 4 2012 -, ... la . - --- TOWN OF QU - :w�'=), BUILDING & OD; . o -= T. Reviewed By. i' I, . Date: /Ill. I .: q ---)7' ' '-:-6,--P-->r" Fr—) , r — 0 0 50100 150 200 Feet