2002-919 TOWN OF QUEENSBURY
41111116kballki 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
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Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020919 Application Number: A20020919
Tax Map No: 523400-279-018-0001-014-000-0000
Permission is hereby granted to: COOKS SEPTIC
For property located at: 1180 RIDGE Rd
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: JOHN & CAROL LAWRENCE
6 ANNA MARIA Ct Septic Alteration Residential
Total Value
FISHKILL,NY 12524-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans& Specifications
2002-919
Residential septic alteration per plot plan and specifications.
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, October 31,2003
(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 To Queen ry; sda , October 31,2002
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System 6 Z(([Ol-
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256 1. OWNER INFORMATION: 1 e ( r it("
n 9 /� r Office Use
Location of installation: /(50 , c c� c, ? 1\�+ C2
f File Pe t No. 0: )2— I rC/
Tax Map No.
/� Fee Paid P
Owner's Name: V k C IL L ci w j- C
Address: /(rr,' / � � ,�L �� Gee 9S,bt>fry.
2. INSTALLER'S NAME : /CS _c\,7C PHONE NO._ — �S
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multipl #o I��
bedrooms with applicable gallons per bedroom to equal total d
Year
of House: No. of Bedrooms x Computation = Total Daily Flow OCT 2 9 2002
C t 98(�or older x 150 gal/bdrm = TOWN OF QUEENSBURY
198 — 1991 x 130 gal/bdrm = BUILDING AND CODE
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes / no
Spa or Hot Tub Installed yes / no
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
FZ" s at what depth at what depth m.
Rolling loam feet feet 4IgraN
Steep slope clay if well; water supply
%slope other from any septic-system
depth: absorption is 4,20 ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect) I i h Gy — If
Rate: minute per inch iv
5. 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 1 ach field for each Garbage Grinder,Spa or Whirlpool Tub.
1.4) 27
Septic Tank / gallon (min. size 1,000 gal.)
Tile Field: each trench a ft. Total System Length: / ft.
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
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 oft e To of Quee ury Sanit Sewage Disposal Ordinance.
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7. SIGNATURE &INFORMATION FOR.itt,Srtn4;$1.014,rr.x.*..n...w,.90,..,.....-,
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TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804 � '\f"-C
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name L A; C0 C..,
LocatioAk \DI(-,E .,;An
Date 10 P i t # i JT-77-9
SOIL TYPE: an o - lay-
Results o e co tion Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: 1
ABSORPTION FIELD: Total Length 11
Length of each trench 2•�?_,.;;N;
Depth of trenches I 6%-71 0; �
Size of stone l ‘1,1 Z
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank ` h, _
Tank to Dist. Box
f _�'�
Dist. Box to Field/Pit tt��1'
Openings Sealed? i Yes ,, No Part alb
LOCATION/SEPARATION
Foundation to Tank (4, j feet
Foundation to Absorption `I_
--feet
Separation of Pits _ eet
Conforms as per Plot Plan J o
LOCATION OF SYSTEM ON PROPERT •
(circle one)
Front - Rear - Left Side Right Sid '
Middle Front - Middle Reasr ---
COMMENTS: 1 i- ire--\'"
'Q ckV
w
SYSTEM USE APPROVED: YES f�NO
Arrived: ► Y
Depart
'i;
it fr
ing Inspector°
i o/zf 2 P'
TOWN OF QUEENSBURY
BUILDING_A .CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name TO 3K 1'L(A
Location j j ry die, Rd
,
Date /0
I381 O Z—Pe rm i t # 2i ""11 P
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size ype
Bldg. to Tank
Tank to Dist. ox
Dist. Box to field/Pit
Openings Se ed? Yes No Partial
LOCATION/S ARATIONS
Foundation to Tank feet
Foundation to Absorptions feet
Separation of Pits '\\ feet
Conforms as per Plot Plan, Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
/tC ore J4 4- X
.�(.4 A
SYSTEM USE APPROVED: YES (/_:
Arrived: 460
Departed:
Building nspector
� 7/ �f 1,0i
w
� j N °�' 9"i have see or observed, or believe I saw evidence of,
s''' wo 1 ail ob ects s ch as houses, wells,trees, fences, etc.,
ill V Q, 1 shown on th s document. I also represent that I have
CS— o 00 'personally eas red a dist. s s t h n the diagram,"Lu
�� . ieTATURE DATE
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