2008-319 .. ' TOWN OF QUEENSBURY
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: P20080319 Date Issued: Thursday, June 26, 2008
This is to certify that work requested to be done as shown by Permit Number P20080319
has been completed.
Tax Map Number: 523400-309-006-0001-069-001-0000
Location: 212 SHERMAN Ave
Owner. EDWARD & BEVERLY KERR
Applicant EDWARD & BEVERLY KERR
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
19
property owner of the responsibility for compliance with Site Plan, 4/
Variance, or other issues and conditions as a result of approvals by the Director of Building& e E ement
Planning Board or Zoning Board of Appeals.
11.6
` TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
ors
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080319 Application Number. A20080319
Tax Map No: 523400-309-006-0001-069-001-0000
Permission is hereby granted to: EDWARD & BEVERLY KERR
For property located at: 212 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: EDWARD &BEVERLY KERR
47 GARRISON Rd Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2008-319
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,June 19, 2009
(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 1(.,:s2sQueelibury; T ursday,June 19, 2008
SIGNED BY r for the Town of Queensbury.
Director of Buil &Cos' Enforcement
r_y
30 7. 6_ / _6- / OFFICE USE O LYE 3/ 2s
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TAX MAP NO. PERMIT NO. ERMIT FEE
APPROVALS: ZONING TOWN CLERK
ir
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJE TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. /�
OWNER: IN k U((���-( de-TA kER-it- INSTALLER: //N J /-Y4/ ,1-e0 p .
S �,,r�
ADDRESS j V"rpk , C/L rJ" , 6 F ADDRESS: P D N O Ni 2 2 I P
PHONE NOS. 7 12'— (K) / /' 6 0 — 09.kr- PHONE NOS. 7 / - 0 Sa
LOCATION OF INSTALLATION:ZI Z S/l Cry M 44 ?Iv e"-knr
NO. RESIDENCE INFORMATION:
YEAR BUILT X COMPUTATION= ' = TOTAL DAILY FLOW
BEDROOMS 4 GARBAGE GRINDER
1980 or older X 150 gallon per bedroom j = 1/ (� INSTALLED? t�0
1981 -1991 X 1 130 gallon per bedroom s = SPA OR HOT TUB
I 1992-present X ? 110 gallon per bedroom =
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 (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: +06 0 GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH Sb FT.
✓ TOTAL SYSTEM LENGTH: 20 V FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X FT.
I 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.
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 these and all requirements of the Town of QUESTIONS? CALL 761-8256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. codes@queensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
,y�_ 6 .-/ ,0� www.queensburv.net
.., ,aS nat6r€of Per n Responsible Date
116 Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection r :ceiv=•
Queensbury Building &Code Enforcement Arrive: ' * .•-•*'• D:/►= - : rr
742 Bay Rd., Queensbury, NY 12804 Inspector's Initi. ;
NAME: Ker , PE* NO.: r / 7
LOCATION: 2/fZ.. . Arh.s � c IN'•ECT ON:
RECHECK:
Comments and/or diagram
Soil Type .n•f) :.aildif ay
Type of Water: un' . ,. Water
Wate 'ne s-•- ation 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 I-} ft.
Depth of trenches i—7 ft.
Size of Stone 1X'2j
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank ti t 1A t
Tank to Distribution Box ''' S f?p h
Distribution Box to Field/ Pit " by 9-1jj$ T '4 --�
Opening Sealed: N
End Cap ___)��N
Inlet/Outlet Pipes&Baffles Y_ N
Location/ Separations
Foundation to tank 1 O� ft.
Foundation to absorption +ft.
Separation of Pits ft.
Conforms as per Plot Plan Y^ N
Engineer Report and As-Built _ Y_ N
Location of System on Property:
Front ar Left Side Right Sid le Front Middle Rear
S em s:
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
Community Development Office
` Town of Queensbury • 742 Bay Rd.
Queensbury, New York •12804 PLOT PLAN a
Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines.
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