2009-082 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. P20090082 Date Issued: Thursday, April 02, 2009
This is to certify that work requested to be done as shown by Permit Number P20090082
has been completed.
Tax Map Number. 523400-301-018-000 1-0 10-000-0000
Location: 730 SHERMAN Ave
Owner. KENNETH & PENELOPE LIBERTY
Applicant: KENNETH & PENELOPE LIBERTY
This structure maybe occupied as a:
Septic Alteration Residential
By Omer 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 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: P20090082 Application Number: A20090082
Tax Map No: 523400-301-018-0001-010-000-0000
Permission is hereby granted to: KENNETH& PENELOPE LIBERTY
For property located at: 730 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: KENNETH & PENELOPE LIBERTY
730 SHERMAN Ave Septic Alteration Residential
QUEENSBURY,NY 12804 Total value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2009-082
septic alteration residential
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, March 25, 2010
(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 Tow eensb� ; �d sda ,March 25, 2009
SIGNED BY �`` for the Town of Queensbury.
Director of Building& Code Enforcement
1 ��' -- OFFICE USE ONLY ,
( TAX MAP NO. PERMITT'NNO. ERMIT ;
10 Q ►1 1
APPROVALS: ZONING TOWN CLERK ;
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT.
A PERMIT MUST B .OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMITT�
, J
OWNER: INSTALLER: (
ADDRESS:_-T �I IV
/`� ADDRESS: t) ✓ ,�:} �� � L l`��
PHONE NOS._ _ `� (,j w� PHONE NOS. 7 1
LOCATION OF INSTALLATION: may VYNCk
YEAR BUILT NO.OF X COMPUTATION= RESIDENCE INFORMATION:
BEDROOMS = TOTAL DAILY FLOW
1980 or older X 150 gallon per bedroom = GARBAGE GRINDER
INSTALLED? W C
1981 -1991 X 130 gallon per bedroom e
1992-present X 110 gallon per bedroom = SPA OR HOT TUB
INSTALLED? w
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling Steep slope %Slo e
P
✓ SOIL NATURE: Sand i / Loam
Clay Other
✓ GROUNDWATER: At what depth?-- --
✓ BEDROCK/IMPERVIOUS MATERIAL: At
what depth?
✓ DOMESTIC WATER SUPLY: Municipal -' � well—/, c�
— (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is I, 3
Per minute 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).
r r�_
TANK SIZE: �S F 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 , d ft. Each trench X
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size
❑ 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.
Am
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection reques eiv
Queensbury Building &Code Enforcement Arrive:
742 Bay Rd., Queensbury, NY 12804 Inspector's Initi
NAME: L P MIT NO.:
LOCATION: NSPECTON:
RECHECK:
Comments and/or diagram
Soil T : San oam Clay
Type of Water: NmiellTal Well Water
Waterline separation distance ft.
Well separation distance ft. h
Other wells: ft.
Well Casing Length 50' + - Y N N/A p
v
Absorption Field: Total length 3=pQ ft.
Length of each trench ft. F FT
De th of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box JA%` L
Distribution Box to Field Pit U., �J Opening Sealed: VY N
End Ca N
Inlet/Outlet Pipes&Baffles N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits Z ft.
Conforms as per PidfWa-h, N
Engineer Report and(As-BuilV V Y N
Location of System Prop
Front Re Left Sid Right Side Middle Front Middle Rear
e e t
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 U\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
111kan,iQy .L'eweiopment u-Utce
Town of Queensbury - 742 Bay Rd.
Queensbury, New York -12804 PLOT PLAN
Show all existing and proposed structures. Indicate the setbacks of all structure d buildings fro I property lines.
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2009-082s `" -
KENNETH LIBERTY SIDE PROPERTY LINE
730 5HERMAN AVE 1 SQUARE _ � FT.
SEPTIC ALTERATION TAX ID 301.18-1-10 €