2001-395 �_ TOWN OF QUEENSBURY
Fo. 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010395 Date Issued: Thursday, June 14, 2001
This is to certify that work requested to be done as shown by Permit Number P20010395
has been completed.
Tax Map Number: 523400-057-000-0001-013-000-0000
Location: 492 RIDGE Rd
Owner: RICHARD X. & CATHERINE TERRY
Applicant: RICHARD X. & CATHERINE TERRY
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
(-)JW yk."—
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
wors 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010395 Application Number: A20010395
Tax Map No: 523400-057-000-0001-013-000-0000
Permission is hereby granted to: RICHARD X. & CATHERINE TERRY
For property located at: 492 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: RICHARD X. & CATHERINE TERR Septic Alteration Residential
492 RIDGE Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
MORNING STAR EXCAVATING
Plans & Specifications
2001-395
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,June 11,2003
(If a bnger 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 Town d ueens ry; Mo da ,June 11,2001
SIGNED BY f- / for the Town of Queensbury.
Director of Building Code nforcement
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
�, Office ScU
Location of installation: 'f90Z / ►Z.�'j I
File Permit No. t Tax Map No. / /
/ r„ .ux • Fee Paid % OO l i
Owner's Name: T PA G►.rr� . l
Address: ;Z fr24 RV) ,
2. INSTALLER'S NAME : //run..." .7p/,. PHONE NO. 9992 2/0
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s)and multiply II of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total D lb` ,w Et V
ED
.0 1y80 or older) 3 x 150 gal/bdrm = y UN 120
1980— 1991 x 130 gal/bdrm = TC7F_
1991present = B
— x 110 gal/bdrm Ua�t ,�
Garbage Grinder Installed yes / no X.
Spa or Whirlpool Installed yes / no X
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
raphy Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
at sand at what depth at what depth Cinun i Zi
Rolling o. /0, feet /o feet well
Steep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
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 leach field for each Garbage Grinder,Spa or Whirlpool Tub.
Septic Tank: fr(ep444,gallon(min. size 1,000 gal)
Tile Field: each trench ft. Total System Length: ft.
Seepage Pit(s): number of size of each: ft by ft.
Size of Stone to be used: it / 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 of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
[g":
Signature of resp nsible person Date
L
7 - '
Town of Queensbury
SeNVel'S anti Sewome Disposol Cho pier
A ppentli x. ('
• i
A IISORPTION Ii'l ELI )
SEPA RATION [UAW I II ENI ENTS
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TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name . CeR v
Location ij Z ric06.,e A .
Date 401 (et( Permit # 0 j -- 37
SOIL TYPE: San•-Loam-Clay-
Results of P:rcol\tion Test-
(if applicable) Rare-Minute/Inch
TYPE OF SYS : : i
ABSORPTION FI LD: Total Length
Length of eac trench
Depth of trenches
Size of stone
SEEPAGE PITS: Num'er-
Size - f . x ft.
Stone siz-
PIPING: Size ype
Bldg. to Tank
Tank to Dist. Bo
Dist. Box to Fiel •/Pit
Openings Sealed? Yes No Pa— rtial
LOCATION/SEPARATII S:
Foundation to Tank feet
Foundation to Abso etion feet
Separation of Pits _ feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM e PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
4q- . of ,e-G0 - o K
SYSTEM USE APPROVED: YE NO
Arrived:
Departed: i
cj/�
Building Inspector
, 4[ a TOWN OF QUEENSBURY
I ' dUUILDING_b_CODE ENFORCEMENT
742 Bay Road /7/
Queensbury NY 12804
(518) 761-8256
CS�EPTIC. DISPOSAL SYSTEM INSPECTION
A.5itt<AIL Z‘Cj—a-Jai-
Location 4 G q(e`
Date j �/ Perini # 9S
SOIL T PE Sand-Loaf lay-
Results of Percolat on Tes-
(if applicable) Ra --Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: etal L •ngthf •Z
Length of each trent h I 5'S
Depth of trenche
Size of stone !'11 : L.l�i1--'De
SEEPAGE PITS: N -r
Size - ft. x ft.
Stone size
PIPING: ize Type
Bldg. to Tank f 9771A7 3
Tank to Dist. Box 540,( 3S�
Dist. Box to Field/Pit
Openings Sealed? Yes N. Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption $ feet
Separation of Pits _ eet
onforms as per P1 of Plana No
LOCATION OF SYSTEM ON PROPERT
(circle --
Front - Left Side - Righ , Side
Middle Fron - Middle Rear
COMMENTS: KT I A C___
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SYSTEM USE APPROVED: YES III
Arrived:
Departed: Eza5,<;//'/, ".,,c___
Building Inspector
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"I have seen or observed, or believe I saw evidence of,
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ail 1:)blfr.ets such as houses, wells, trees, fences, etc.,
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