2000-466 Certiticate of Compliance
Town of Queensbury
Warren County, New York
,Tune 30, 2 U G O 0
Date
G 1, 2000456
This is to certify t wor requested to be done as shown by Pen-nit Na.ap
has been completed.
SEPTIC ALTERATION
This structure may be used as a
42 COTTAGE HILL Ri7 .
Location
Owner �_. RIEBOW r RICHARD SR . e &
'FAX MAP NO . 9 7 . - 1 - 5
By Order 7"owra fiaarci
TOWN OF QUEENS y
Director of Building & Code E?nforcerr ent
BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury, NY 12804
County of Warren (518) 761-8256
VALUE $ 0 Building Pertnit No. 2000466
TAX MAP NO . 9 7 - - 1 - 5
Permission is hereby granted to RIEBOW + RICHARD SR . , &
Owner of property located at 42 COTTAGE HILL RD .
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 coxnplsance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance_
Owner's Address:
RICHARD JR . 42 COTTAGE HILL RDa
QUEENSBURY , NY 12804
Contractor or Builder's Name:
I . B . S . SEPTIC
Contractor or Builder's Address:
2 LOWER WARREN STREET
QUEENSHURY , NY 12804
Electrical Inspection Agency:
Type of Construction:
SEPTIC .
Plans and Specifications:
ALTERATION AS , PERa. MOT- PLAN SPMC FICAT.IONSi �
Proposed. Use:
SEPTIC ALTERATION
25 PER 41T FEE P1�W'— TiIS PE�.I+v�'I''T�xEXPIEtES June 3 � , 2002
(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 Torun of Qtieensbury thus " 3® y`of June . 2000 ..
S1C,NgD BY t � - for the Town of Queensbury
rcement Officer
Application for Permit - Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1 . OWNER INFORMATION:
Office Use
Location of installation:
File Permit No.
Tax Map No. I / _z
0 / /
Owner's Name: /, Z ['r .�r +� / C. I t; f�{ 1�? [nr./ Fee Paid
Address +►J" , ,R.I'
2. INSTALLER'S NAME PHONE NO, /
3. RESIDENCE INFORMATION: (circle year off dwelling, indicate # bedroom(s) and multiply # of
bedrooms with applicable gallons per bedroom to equal total dailyftow)
Year of House; No. of Bedrooms x Computation = Total Daily Flow
1980 or older '�i _ x 150 gaVbdrm — 7` d
1990 -- 1991 x 130 gaVbdrm
1991 — present x 110 gallbdrm �RR A�47
Garbage Grinder Installed yes I no JUN 3 0 2000
Spa or 'Whirlpool Installed yes _ I no
yr,
4. PARCEL INFORMATION: (circle applicable information & indicate measurements
(�` lUL_ _S r round Water Bedrock or impervious i+viateriai Dons tic 'Water Sup_pjy
• at nd at what depth at w �a,�depth municipal
feet O&A feet well
Steep slope clay ifwell; water supply
slope other from any septic-system
depth: absorption is ll
other
Percolation, be completed by licensed pro t)fessional engineer or architect)
Rate; minute per inch
5. PROPOSED SYSTEM: Fpf 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: d!3 gallon (min. size 1, 000 gal.) & '! t
Tile Field: each trench ft. Total System Length: _ 1Z
Seepage Pit(s): number of size of each: fP, by fl.
Size of Stone to be used: ii / depth or thickness ,feet
Bad System Sine: x
Alternative S / 1 ystettt: �(,,. �rrgA-J' length and/or size � •
G. 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 wn of Queensbury Sanitary Sewage Disposal Ordinance.
gnature of responsible person Date
TOIK OF MIEENSSURT
BUI0I� b Cool!. ENFORC
Queensbur- y-
4
(518) 761-8256
SEPTIC DISPOSAL
SISTE14 IRSPECTION
13ame ' LL
r
l._ocati on
�.
.` er"' t
i Date _ r
SOIL TYPE: San
.Loam Cl ay-J--�—r�'.�--
rd
Percolation Test'
Results of Rate-MinotelInch x
( if applicable TYPE OF SYS�I: Total en
Ag,pRpT ICNI FIEto:
Length of each trench
pepth of trenches
/i L- E
Size of stone caber- ft .
SEEPAGE PITS=Size
Stone ype
size_.� �- �-�� 7" iize
• ,arc r� v t
pIPIH6to 'Tank
Ij �ldg - k v+
Tank to Dist ` ieldlP N o art" a
Dist 8 Sealed! Y .
pp en i ng SEPA'R1�'TIi1�lE f eet
LOCATIONI Tank feet
Foundation toss Ab sovqti on � feet
Foundation of l
pits es No
Separation er PI pan
Conforms as pYSTF 0 pl{OPER
L[?CATI _ Rig ht side
( circl one Le Side
Front Rear Mi dl a Rear
Mi ddl a rout
COPS `
,t
` Nd _.
� � J
b j
JUN 3 0 2000
p ' 11 1r •* .
}
"I have seen or observed, or bellim ! saw iilifem e! ot
all objects such as houses, wok heed. 140M 4W.
shown on this documw& I An ewit f* f Ire
personally measured the disbimm od fWSI M 90
ty
SIGNATUREOJI `
QUEEN
"t7sed on Durum' f. 19EPAr?rl&fEN7
wmplianee exa naacny
not be our+�om
Cornplr'a d SPeciTicadions are inhe
ce ltYsj }V; ^r)c Jul
d
TOWN OF QU ENSBUR Y
�o�®4ss 970 _ a _ s BUILDING &
On
AtIEWW� p _
4200
'1"' 'AGE l , 3R .no, , & '� F�2EVIEWED BY 1
,..►c.DATE
� � ar � c 60 we