2006-651 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CE RT I F I CAT E OF COMPLIANCE
Permit Number. P20060651 Date Issued: Wednesday, September 20, 2006
This is to certify that work requested to be done as shown by Permit Number P20060651
has been completed.
Tax Map Number. 523400-301-006-0002-067-000-0000
Location: 19 WESTLAND Ave
Owner. ANDREW & KERRI SHPUR
Applicant: ANDREW & KERRI SHPUR
This structure may be occupied as a:
Septic Alteration Residential
By Osier 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 E oree nt
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: P20060651 Application Number. A20060651
Tax Map No: 523400-301-006-0002-067-000-0000
Permission is hereby granted to: ANDREW &KERRI SHPUR
For property located at: 19 WESTLAND 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: ANDREW &KERRI SHPUR
Septic Alteration Residential
19 WESTLAND Ave
QUEENSBURY,NY 12804-0000 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2006-651
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, September 19, 2007
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensb before the a iration date.)
Dated at the To of e b T eptember 19, 2006
SIGNED BY vv for the Town of Queensbury.
Director of Building&Code Enforcement
OFFICE USE ONLY��________________________
TAX MAP NO. PERMIT NO. PERMIT FEE_�� ' '
o APPROVALS: ZONING TOWN CLERK SEP 1 $ 2006
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: kla� � INSTALLER: ✓� c '�
ADDRESS: 2 -G'ADDRESS: JO?
PHONE NOS. `1 2 0 PHONE NOS
LOCATION OF INSTALLATION:
.......................................................................................................................................................................................;...........;..........................................................................: RESIDENCE INFORMATION:
NO.OF ! I
YEAR BUILT X i COMPUTATION= = TOTAL DAILY FLOW
3 BEDROOMS i ........................................................................ GARBAGE GRINDER
i 1980 or older 1X 150 gallon per bedroom 1 _ INSTALLED?
.....................................................................................:..........}.......................................,..................,.............;} ..... '• ................................................................... e... .......
1 1981 -1991 i I X 130 gallon per bedroom ? = i 3 b i SPA OR HOT TUB
.......................................................— ...,.....................,....,......;..............................,..............,..........,................;...........i.......................................................................... INSTALLED?
i 1992-present ' ,+ X 110 gallon per bedroom _ ;
i................................................x.....................,.. ..........................................................................:...........,................................................................
..........
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLA ROLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND_ LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? la BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH? f
✓ DOMESTIC WATERJJJ__S"'UPLY: MUNICIPAL_ WELL
(IF WELL: WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. )
✓ PERCOLATION TEST: RATE IS /_ <' PER MIINUTE 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). Add 250
gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub.
✓ SEPTIC TANK: GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH VO FT.
0
✓ TOTAL SYSTEM LENGTH: :200 FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X FT.
✓ SIZE OF STONE TO BE USED: # /DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(if required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY: GAL.
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:.:...:.:.:...:.:...:.::.:.:.....:.:.....:.......:.....:.:.:.:.:.:.....:.:.:.:.....:,.:.,.:.,.:..................................... ,............::,....::..:,.......:.:,.:.....:..,..
w NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
I;
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
li....:: :::: ::..:::.:...:..... .....:.:. .:: .:.: . . ..:. .. ... ..: ...........:....:.:........:.....:.........:..:....::......::.... .:::.:::.:.::.:::.:.....:......::.:..:
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 :QQU:ESTIONS? CALL 761-8256 OR EMAIL
Queensbury Sanitary ge Disposal Ordinance. codes@ciueensburv.net
VUR WEBSITE FOR MORE INFORMATION
www.aueensburv.net
Signature of P.s�son Responsible Date
Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804