2004-764 TOWN OF QUEENSBURY
Flit 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20040764 Date Issued: Monday, November 29, 2004
This is to certify that work requested to be done as shown by Permit Number P20040764
has been completed.
Tax Map Number: 523400-297-010-0001-052-000-0000
Location: 667 RIDGE Rd
Owner: ALEX ALEXANDER
Applicant: ALEX ALEXANDER
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code nforce ent
Olak TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
On"
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040764 Application Number: A20040764
Tax Map No: 523400-297-010-0001-052-000-0000
Permission is hereby granted to: AT EX AT,EXANDER
For property located at: 667 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: ALEX ALEXANDER
P.O. BOX 4024 Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2004-764
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday, October 08, 2005
(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 Town of nsbury; Friday October 08, 2004
SIGNED BY for the Town of Queensbury.
Director of Building&Co Enfo meat
4Lt'� n
Application for Permit-Septic Disposal System 5
I oo'JI(f QJJeeiishii)�7•12 Bay Road Queenshwy, NY 12801 (.518) 761-8 256 \ c f��. - \ p19,
1. OWNER INFORMATION:
Location of installation: 667 Ridge Road Office Use
File Permit No: 11)L7 /
()
Tax Map No. 297.1t7 1 / 52
• Fee Paid
Owner's Name: Alex & Linda Alexander
Address: 667 Ridge Road, Queensbury
2. INSTALLER'S NAME : PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate 11 bedroom(s) and multiply II of
bedrooms with applicable gallons per bedroom to equal total daily/low)
Year of House: No. of Bedrooms x Computation_ = Total Daily Flow
1980 or older x 150 gal/bdrm =
1980- 1991 x 130 gal/bdrin =
1991 -present 3 , x 110 gal/bdrm = 330
S 2 7 2004
CODE
Garbage Grinder Installed yes / no x TOM
l Q�Fp
Spa or Whirlpool Installed yes / no x BUlLD1 £ EIVSBURY
- -w_' ' D
•
4. PARCEL INFORMATION: (circle applicable information & indicate measurements) SEE PLANS
Topsigfi )by S.Q Nasure .Qround Water Bedrock or h»pervious Material�._Domestic._Wat r Supply
Nat sand at what depth at what depth municipal
Rolling loam feet feet well
Steep slope clay if well; water supply
%slope other from any septic-system
depth: absorption is ft.
outer
Percolation Test: (To be completed by licensed professional engineer or architect) --�
• Rate: See Plans 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 I3oard 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: gallon (min. size 1,000 gal) SEE PLANS
Tile Field: each trench - ft. Total System Length:
Seepage Pit(s): number of size of each: ft. by ft. N/A
Size of Stone to be used: It / depth or thickness feet N/A
Bed System Size: x N/A
Alternative System: length and/or size N/A
6. HOLDING TANK SYSTEM: (if required) N/A
Number of tanks: / Size of each: gallons /TOTAL Capacity: gallntts
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.
Signature of responsible person Date
Septic Inspection Report
Office No. (518)761-8256 Date Inspection eque.t re i d:
Queensbury Building&Code Enforcement Arrive: am/,m epart: 1.}Db a p�)
742 Bay Rd.,Queensbury,NY 12804 Inspector's Intl;
NAME: R 1 �C .4 IT NO.: 2'-, —71cLj
LOCATION: N "ECT ON: t — r —C
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay _ f
Type of Water: Municipal/Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/Pit
Opening Sealed: Y/N/Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits /ft.
Conforms as per Plot Plan Y!N vE�
Location of System on Property: \� � Q -nOG
Front Rear Left Side Right Side
Middle Fr nt Middle Rear
S stem Use St us:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC. cj
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No. Cert. 0 4 Cut-in Card No ,C
Dwner /�y'� L e/Q-1-)
Location /"` P 6 ,24 a /�
[nstallation Consisting of c Q 6Z" Cgs '%/�-� - C.-! 614-/
PI1- rvd0
[nstalled By A, SP rCiv Lic.No.
The conditions following governed the issuance of this certificate,and any certificate previously issued is
ancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
ntroduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of maki nspections at any time, and if its
ales are violated,the Company shall have the right to e ke ertific
date INSPECTOR
Member N.F.P.A.,I.A.E.I.
9— / -
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection r;sues rem,: r
Queensbury Building&Code Enforcement Arrive: am/4 )1 t epart: ` �'1 a
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initi. s• .0, C
NAME: \C C. C� IT NO.: O t --7(OLt
LOCATION: 1 1 ,SPECT ON: ll—a °=10
RECHECK: /
Comment and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water - f
Waterline separation distance ft. rho
Well separation distance ft. q
Other wells: _ ft.
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number qs��)-) D\A ft.'
Size: - x
Stone Size:
f
Piping Size _ Tye
Building to tank F I N'RL ELF-CT(2.t CAL. %ocq
Tank to Distribution Box
Distribution Box t e /Pit
Opening Sealed Y /Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan .. Y--N
Location of System on Property:;
Front Rear Left Side Right Side
Middle Fro Middle Rear
S stem Use Sta s•
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
-Disapproved
L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
Septic Inspection Report
Office No. (518)761-8256 Date Inspection re. -- -ce• er
Queensbury Building&Code Enforcement Arrive: �'��•art `
742 Bay Rd.,Queensbury,NY 12804 Inspector's Ini '. . '
NAME: � �3 Y o 4L-
LOCATION: t A., i `'` . 3 rj (r SPECT ON: - -
RECHECK:
•
Comments and/or diagram
Soil Ti.- oa Clay
Type ► r: Munic• Well Water
Waterline se.: : '.n •istance ft.
Well separation distance _ ft.
Other wells: ft.
Absorption Field: Total length 7 ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone e 1 ` - . \ -�7
Seepage Pits: Number
Size: x
Stone Size:
Piping ze Type
Building to tank '
Tank to Distributio Box Z. -? )N--N W96 V'3 C..-
Distribution Box to Field/Pit -rc> \j F1\- PO,°'�-�
Opening Sealed: Y/ rtial)
Location/Separations 0 6
Foundation to tank 1c ft. ® � 0
Foundation to absorption ft. F?3M?)
Separation of Pits ft. j
Conforms as per Plot Plan J Y—N ' Ft P'
Location of System on Property:
Fron 4ff L- t Side fight Side
Middle Front Middle Rear
System Use Stat s:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
L:\SueHemingway\Building.Codes.tnspcction.FORMS\Septic Inspection Report.doc January 28,2003