97-391 . .
_
_
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19
July 18 97
This is to certify that work requested to be done as shown by Permit No. 97391
has been completed.
• This structure may be used as a SEPTIC ALTERATION
location 1689 RIDGE RD.
Owner BRUHNS , JOHN
By Order of Town Board
TAX HAP NO , 27 , -178 TOWN OF QUEENSBURY
41IP
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 97391
TAX MAP NO. 27 . -1-8 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to
BRUHNS, JOHN
OWNER of property located at
1689 RIDGE RD. Street, Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC ALTERATION
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. OWNER'S Address is
1689 RIDGE ROAD
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
BRUHNS , JOHN
3. CONTRACTOR or BUILDERS Address
4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( I Masonry ( )Steel ( 1
7. PLANS and Specifications
SEPTICN0ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 July 10 99
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
10 July 97
Dated at the Town of Queensbury this Day of 19
SIGNED BY S. V- A —N for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No.q7-
Dept. of Community Development
Building &Codes Office
742 Bay Road Fee Paid $
Queensbury, NY 12804
Location of property for installation: 2J— t —
Property Owner's Name: 1--k P*p,U k
Property Owner's Mailing Address:
Installer's Name: /)FkC`'1 R6 gei-ME Phone # -7q71"Z__ckZ_I
Number of bedrooms (if residential): Total daily flow:
AIL. I. 1997
(residential - compute @ 150-gal./bdrm.)
Topography: flat, rolling, steep slope q of slope
Soil Nature: sand, N4oam, clay, othc/depth:
Ground water: at what depth? feet / Bedrock or Impervicus Material: at what depth? _ feet
Percolation test: not required, requXell,
red [rate min. per inch ]
Domestic water supply: municipal, cd:er
If domestic water supply is a WET.L, water supply from any se c absorption is 1 00N-feet.
PROPOSED SYSTEM
Septic tank: 1Oc ) gallon (minimum size: 1,000 gal.)
9)e_o
Tile field.-each trench O feet / Total system'eigth: S'-j', feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: # Z_ / depth or thickness I feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
Alarm system and associated electrical Rork to be inspected by a certified agency.
For your protection, please note that pursuant to Section 136-29 of tie Code of ze 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
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: x' Date: 9//C?/ F7
TOWN OF QUEENSBURY
BUILDING S CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DIY POSAL SYSTEM INSPECTION
Name ID
Location RIME_F Rcw O
Date Permit # C7 i t
SOIL TYPE:ca
rtt :
Results of Percolation Test-
(if applicab ) Rate-Minute/Inch
TYPE OF SYST :
ABSORPTIION FI D: Total teng'h
Lngth .'-s != enc
Depthof - 1-1 ILAI
Size of stone 'i
SEEPAGE PITS:
umber-
Size - t. x ' ft.
Stone size
PIPING: ; {} Size Type
Bldg. to Tank T
Tank to Dist. Box-' i' P�
Dist. Box to —7.*-'.-- tt s'.
Openings Sealed?_' 9 " No Partial
LOCATION/SEPARATl+
Foundation to Tank * feet
Foundation to Abso •`'= ion 2i-ri- feet
Separation of Pits • lam-- feet
Conforms as per Plot • an .tom No
LOCATION OF SYSTEM ON`:'ROPERTY:
(circle one)
Fact - Bear - Left Side - Right Side
411101dle Front')- Middle Rear
COMMENTS:
N
SYSTEM USE APPROVED: 411,11
NO
Arriv
Dep • a
B ilding In
-7 nave seen or comma.or Down ram Mau of
• . all objects such as homes,sok trom fame.dr.,
shown on this document I also represent lhet 1 hew
personally measured the didaoes set forth on the dram."
SIGNATURE DATE
RENnhED
PLOT PLAN 71 1 q1
SEPTIC SYSTEM
Notice: The following statement must be "stamped" on your plot
plan. This sheet of paper may be used for purposes of drawing your
plot plan. After drawing such plot plan, please read the statement
and sign it. If you choose to use other paper for your plot plan,
the office will stamp those plans for your signature.
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BUILDIN : y6?-7 _f
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REVIEW ED 2 . / _ -. r _ - �- �— ._.. -..� 5.
DATE - ' - - f -- — ti Ee '�ji
L
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name �I
Location
Date -T I'l cf7 Permit # =A-)-
i
SOIL°TYPE: Sand-Loam-Clay-
Results of Percolation Test
(if applicable) Rate-Minut /Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total L ngth
Length each trench
Depth of trenches
Size of s one t
SEEPAGE P TS: Number-
Size - ft. xiri ft.
Stone size 1
PIPING: '_ Size Type
Bldg. to Tank
Tank to Dist, Box
Dist. Box to Field/Pit
Openings Sealed? :Yes No Partial
LOCATION/SEPARAflON4:
Foundation to Tank 1 feet
Foundation to Abso'ption feet
Separation of Pits) feet
Conforms as per P t Plan Yes No
LOCATION OF SYSTE ON PROPERTY:
lo
(circle one) '
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
3
i
SYSTEM USE 4PROVED: YES 4_,./Tt '
Arrived: \
1
Depar :
B ing nspe o
i;
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name AO (2)P,t*t)
Loca ion c2 XE /P'LTPU)
Date Permit #97- q
SOIL TYPE: Sand-Loam-Clay.
Result1 of Percolation TCst-
(if applicable) Rate-Mirk to/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total;Length
Length of each trench
Depth oftrenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x I _ ft.
Stone size.
PIPING: Size Type
Bldg. to Tank TI OG
Tank to Di s ox 411
Dist. Box t L{"
Openings Sea}.ed? Yes No Partial
LOCATION/SEPARAATIO iS:
Foundation to Tank/ Edeet
Foundation to Absorption '2 p t feet
Separation of Pia feet
Conforms as per Plot Plan Yes QED
LOCATION OF SYSTI ON PROPERTY: R VE
(circle one) t
Front - Rear - heft Side - Right Side
le Front)- liddl.e Rear
COMMENTS:
� It
fr
40 CP
SYSTEM USE APPROVED: NO
Arrived:
Depar - $7b �10p-$00'
`..
.ildin. nsp1 ,r
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC OISPOSAL SYSTEM INSPECTION
A
Name `J 0 NIJ 1\-‘0„1")
Location 4 R►�(,F RDA ---)
Date -7I7 1 Permi # 97 jq 1
SOIL TYPE: Sand-Loam-C/ay-
Results of P'ercolati•. Test-
(if applicabre) Rate inute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: T-tal Length
Length of each tre h
Depth of trenches
Size of stone
SEEPAGE PITS: 'u'°ber-
Size - fr x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. • x
Dist. Box to F ''eld/Pit
Openings Seale ? Yes No Partial
LOCATION/SEPA''JIONS:
Foundation to Tank feet
Foundation t. Absorption feet
Separation o ` Pits feet
Conforms as er Plot Plan Yes No
LOCATION OF YSTEM ON PROPERTY:
(circle one
Front - Re. - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
BE cF brc E- t n\ 4-ACE
b t Z_ 0 F- c3ED TE P-k
1142: �.F A DO of ‘.5' i,11)
SYSTEM USE APPROVED: YES
Arrived:
Depart
uilding s ector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name . -0H13 )RU I-k
Location IL:, IL, i
Date fw Permit # C17 391
SOIL TYPE: S4 d-Loam-Clay-
Results of Pecolation Test-
(if applicably Rate-Minute/Inch
TYPE OF SYST
ABSORPTION FIEki: Total Length
Length of each rench
Depth of trench=s
Size of stone
SEEPAGE PITS: N ber-
Size - ft x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/' 't
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:,
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits feet
Conforms as per Plot P1 n Yes No
LOCATION OF SYSTEM ON P PERTY:
(circle one)
Front - Rear —Left Side Right Side
Middle Front Middle Rear
COMMENTS:
°1 -6V3ik-A) -61'0014
NftZ
\704\‘
SYSTEM USE APPROVED: YES NO
Arriv ' a
Depa ed
. ice.
:ui ding spector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name F Fi!0 VRlA-43_I
Location ‘fE RQAn
Date ct7 Permit # (C.,
SOIL TYPE: Sand-Loam-Clay sk.Y1 -31 )
-
Results of Percolation Test-
(if applicable) Rate-Minute Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: To al n th
Length of each trenc
Depth of trenches
Size of stone
SEEPAGE PITS: Numb -
Size - ft. ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption 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:
cCA a
SYSTEM USE APPROVED: YES NO
Arrived:
Depa ed:
wilding In ctor
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ci V)t-k
Location tic c' _ 14:SkL_ ____N2NOE:
Date -7\7‘VV7 Permit #
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) R. e-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION ELD Tot.l Length
Length of eac ench
Depth of trenche.
Size of stone
SEEPAGE PITS: umber-
Size - 't. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption 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:
c2R-0-- Ob qy3,P_______
3E V C 4
'B%k- TEE-EE- \<t 1306).)Nl
SYS USE 'P'R �\ YES-
, 1
il .
Arriv - , /ram � cD �•_
Dep. ed: 47 1 'oc� �t ki`l
'Al!, iEW%-ilate
, _Ilia 7� 1- 1� l5 IQ
7 Bui1 n:. Inspector 1A,V00
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 13R1)140
Location _ C1ne,E RnPiCo
Date 1 Z1�$tc�(Q Permit #
.C.D___Mar—
SOIL TYPE: Sa1nd-Loa Cl�aY- v
Results of Percolation Test- /
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total L:ngth
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Bo
Dist. Box to Fie d/Pit
Openings Sealed Yes No Partial
LOCATION/SEPAl . IONS:
Foundation to ank feet
Foundation to Absorption feet
Separation of Pits _ feet
Conforms as 4-er Plot Plan Yes No
LOCATION OF YSTEM ON PROPERTY:
(circle one
Front - Re.r - Left Side - Right Side
Middle Fro . - Middle Rear
COMMENTS:
,_.a .‘c_ VmTaER6
1
V\-\----- ‘)A6 m___ —\--atLf -rV,
SYS A �`O g*Att- VYES N
Arrived• T
Depar „i
""ilding Inspector
L
f 1 have seen or observed.or believe 1 sew evidence et,
all objects such as Massa ink levee,fens. ie
shown on this dopeenent.$gibe represent th I have '
personally ineessred the distances set AIM on the Via."
"7/O/F?
SIGNATU DATE
.
PLOT PLAN
SEPTIC SYSTEM
Notice: The following statement must be "stamped" on your plot
plan. This sheet of paper may be used for purposes of drawing your
plot plan. After drawing such plot plan, please read the statement
and sign it. If you choose to use other paper for your plot plan,
the office will stamp those plans for your signature.
Vc43"-
IDE..
1111010
IJo* 2, diiii;
'Tb.we viz, i .
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A
f997
TOWN OF : . : , Y igig81, t' Y-Iliel
BUILDING // ,�
REVIEWED BY (�` _ �T `�- `"
7 DATE _ e i �,... CI4,,it
to
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