BOTH-000013-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000013-2016 Date Issued: Friday, December 22, 2017
This is to certify that work requested to be done as shown by Permit Number BOTH-000013-2016
has been completed.
Tax Map Number: 266.3-1-55
Location: 1640 RIDGE RD
Owner: SETH STARK
Applicant: DEV1N DICKINSON
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the )04P 4 44t
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 QUEEN BURY
742 Bay Road,Queensbury,NY 1291(94.50(94 (514)761-4201
ii
Community Development- 'Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: 13O"l`H-000013-201
Tax Map No: 266.3-1-55
Permission is hereby granted to: SETH STARK
I'or property located at: 1.640 RIDGE Int}
In the Town ol'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
Owner Name: SETH STARK Septic Disposal $0.00
Owner Address: 1644 Ridge RD `Dotal Value WOO
Queensbury,NY 12404
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT IEE PAID-THIS PERMIT EXPIRES: Friday,January 13,2017
{II'a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town ol`Queensbury before the e iration date.
11
Dated at the Town Queens y; Tu a�nuary 19,2016
SIGNED BY: � liar the°Town of"Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT Office Use Qnty
DATE 12, )16 Received
I Tax Map ID
TAx MAP ID 3 Permit No. UTN* 2.,o I,\,e
LocATIONOFINSTALLA Permit Fee !�Alfj
Approvals:
APPLICANT NEI E-MAIL
2016
ADDRESS
IAI$TALLERIS �'-'3 J PHONE✓E-mAiL
ADDRESS:
0
OWN PHONE IE-wx
Address16 Y �'O - Q /u
CONTACT PERSON FOR BUILDING CODES COMPLIANCE PHONE=W- /,5-1
Rgstaviyog MEQ8MA TION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed Y N
1981-1991 Spa or Hot Tub installed —Y
1992-Present H)4T.90P
PARCEL INFORMATION
Topography Flat rolling Steep slope %slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth? VO 7
Bedrock/Impervious Material At what depth?
Domestic Water Supply —Municipal �Well(if well,water supply from any septic system absorption is,&C ft.)
Percolation Test Rate: -J-i—0 per minute per inch(test to be completed by licensed engineering/architect)
PRoPosED SysTEm Eog NEw QNSTRUCTION
Tank SizeM gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length 2- 0 ft,;Each trench x
Seepage Pit with#3 stone How many: _,size_
Alternative System Bed or other type?
Holding Tank System Total required capacity? Tank size #of tanks
Nom s: 1)Alarm system &associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer
allow systems to be covered until such time as an As-Built plan is received & approved. The installed system must match the septic system
layout on file-no exceptions.
DECLARAWN: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or
failure to make a material fact or circumstance know by or on, behalf of an applicant, shall be void. I have read the regulations
and agree to abide by,&ese anl!all requirements of the Town of Queensbury Sanitary Sewageisposa Ordinance.
Print Name: Date: 1i
Signature: Date-
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
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