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2002-651 TOWN OF QUEENSBURY woo742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20020651 Date Issued: Tuesday, August 06, 2002 This is to certify that work requested to be done as shown by Permit Number P20020651 has been completed. Tax Map Number: 523400-289-011-0001-020-000-0000 Location: 6 HALL RD. EXT Owner: CHARLES & SUSAN OGDEN Applicant: CHARLES & SUSAN OGDEN This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Director of Building&Code Enforcement TOWN OF QUEENSBURY F 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 IL E COPY ;TM Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020651 Application Number: A20020651 Tax Map No: 523400-289-011-0001-020-000-0000 Permission is hereby granted to: CHARLES & SIJSAN OGDEN For property located at: 6 HALL RD. EXT 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: CHARLES & SUSAN OGDEN 4 HALL RD. Ext Septic Alteration Residential Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2002-651 Septic alteration per plot plan& specifications. $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,August 01,2003 (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 Town of Q eensb ; TWIrsdity gust 01,2002 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit—Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: T Office Use Location of installation: if If �L i File Permit No. al G'Oa 6.57 Tax Map No. / / Fee Paid Owner's Name: C- Address: 2. INSTALLER'S NAME : ' -i E S:2(.3 PHONE NO./l 7'7' 3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s)and multiply# of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No.of Bedrooms x Computation = Total Daily Flow 1980 r ' 3 x 150 gal/bdrm = 1 NZ 980—1991 x 130 gal/bdrm = 1991—present x 110 gal/bdrm = ray •> >y= � � 7,at, d ..i rF _�. Garbage Grinder Installed yes_ o� Spa or Whirlpool Installed yes— / 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) To oeranhv Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply (Flat) at what depth at what depth municipal Rolling oam feet feet Cf► Steep slope clay ifwell;water supply %slope other from any septic-system i depth: absorption fore 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:/c) ccc 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: # / depth or thickness feet Bed System Size: /0 — A 4 x Alternative System: f_--S e'1 length and/or size /O 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 Sancfriuitary Sewage Disposal Ordinance. Sig is r of responsible person Date TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name 019012/0 Location , Date 7iPermi t # gOO, - j SOIL TYPE• Sand oam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length (, Length of each trench/ Ze, ' Depth of trenched. Size of stone C L Je,J 45e,,,,S SEEPAGE PITS: Number- Size - ft. x ft. Stone size PIPING: Size Type Bldg. to Tank Tank to Dist. Box ::Ii;; �O Dist. Box to Field/P. 'sia 5 Openings Sealed? (9No 'artial LOCATION/SEPARATI• Foundation to Tank feet Foundation to Absorption feet Separation of Pits _ eet Conforms as per Plot' Plan 40No LOCATION OF SYSTEM oN PROPERT (circle one) `N_ Front - Rear - Left Side ight Si Middle Front - Middle ar COMMENTS: ©�o S ia� SYSTEM USE APPROVED: YES NO Arrived: --- Departed: c,,PC Building Inspector RECEIVED (('j\/) v. ` ve `U 1 r \J \• IL-11 __\\0? ..vels s TOWN 0 F QU►ENSBURY BUILDING , S T REVIEWED BY/ DATE vi 1 l C.Ae to a C---.0 V I M r 1 .fp ..., ' '' "' ''. .7:'.S . . EA.) 6--Veer f 4