1999-275 CERTIFICATE OF COMPLIANCL.
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date July 2 19 99
99275
This is to certify that work requested to be done as shown by Permit No.
has been completed.
This structure may be used as a SEPTIC SYSTEM
Location 1177 RIDGE RD. "
Owner SAUNDERS, RUSTY & NANCY
TAX MAP NO. 51 . -1-23 By Order of Town Board
TOWN OF QU SBURY
apie,
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY Na 99275
TAX MAP NO. 51 . -1-23 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to SAUNDERS, RUSTY & NANCY
OWNER of property located at 1177 RIDGE RD. Street, Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC SYSTEM
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNERS Address is
1177 RIDGE RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDERS Name
SAUNDERS, RUSTY
3. CONTRACTOR or BUILDERS Address
1177 RIDGE ROAD
QUEENSBURY, NEW YORK 12804
4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( I Masonry ( )Steel 1 1
7. PLANS and Specifications
SEPTIC SYSTEM, 4 BEDROOM HOUSE, AS PER PLOT PLAN AND
SPECIFICATIONS
8. Proposed Use
SEPTIC SYSTEM
25 May 26 19 2001
$ PERMIT FEE PAID —THIS PERMIT EXPIRES
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date.)
26 May 1999
Dated at the Town of Queensbury this Day of 19
' \j
SIGNED BY for the Town of Queensbury
Building a Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept. of Community Development Permit No.
Building &Codes Office
742 Bay Road Fee Paid $
Queensbury, NY 12804
Location of property for installation: //-2? t2,`ak
Property Owner's Name: £4
Property Owner's Mailing Address: /1 7? <"O,e cek, 1 L7
Installer's Name: 5 6 r�
��'�� � Phone # a 3 0 5'
Number of bedrooms (if residential): 47 Total daily flow: 600
(residential -compute @ 150 gal./bdrm.)
Topography: flat, rolling, steep slope % of slope
Soil Nature: sand, )0 loam, clay, other /depth:
Ground water: at what depth? ti//4-feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: (G not required, required [rate min. per inch]
Domestic water supply: /� municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is /0O feet.
PROPOSED SYSTEM
Septic tank: /5))gallon (minimum size: 1,000 gal.)
/00
Tile field: each trench 'O.) feet / Total system length: o?SO feet 1 Lr/
Seepage pit(s): number of / size each: . ft. by ft.
Size of stone to be used: # 0 . / depth or thickness / feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
(
Alarm system and associated electrical work to be inspected by a certified agency.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queens bury, 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
Queensbury Sanitary Sewage Disposal .
Signature of responsible person: Date: l 1��
- c)))T)
- TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name Q ZC/\.) �-S
Location \\ i (cc,ei
Date 7 - 0-91 Permit # '�-04
SOIL TYPE: San4-Loam-C ay-
Results of Percolation Test-
(if applicable) Rate-Mi , a/Inch /
TYPE OF SYSTEM: /
ABSORPTION FIELD: T.tal L-n•)h
Length of each tr: ch a. w 6V05 e-o
Depth of trenche �a
Size of stone
SEEPAGTS_ lumbe
Size - x ft.
Stone size _-
PIPING: Sizes- Type
Bldg. to Tan-
Tank to Dist Box hc.p
Dist. Box ti Field/P't A t4
Openings Sealed? es No Partial
LOCATION/SEPARATION
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits eet
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPERT .
(circle e)
Front Rear - Left Side - Right Side
Middle F . - Middle Rear
COMMENTS:
:.0ecz- - O11
SYSTEM USE APPROVED: YES NO
Arrived:
Departed: 5
Building Inspector
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Produced by the Town of Queensbury, NY, Planning Department
05/26/1999