2000-653 TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY 12804-5902 (518) 761-9201
Community Development - Building & Codes (518) 7614256
CERTIFICATE OP COMPLIANCE
Permit Number: P20000653 Date Issued. Thursday, August 31, 2000
This is to certify that work requested to be done as shown by Permit Number P20000653
has been completed. 6 4 ..s
This structure may be used as a Septic AlterationResidentiAl
Y P
Tax Map Number: 523400-06&000-0004-009-000-0000
Location: 6 CEDARWOOD Dr
Owner: CHRISTOPHER CORNELL
By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
TOWN OF Q►UEENSBURY
(at 742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201
Community Development - Building & +Codes (518) 761-8256
BUILDING PERA41T
Permit Number: P20000653 Application Number: A20000653
Tax Map No: 523400-068-000-0004-009-000-0000
Permission is hereby granted to: CHRISTOPHER & COR.NELL
Owner of property located at: 6 CEDARWOOD Dr
in the Town of Queensbury, to construct or place a Septic Alteration Residential
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.
Owner Address: CHRISTOPHER & CORNELL
JENNIFER PEARSON
6 CEDAR'WOOD Dr
QQUEENSBURY, NY 12804
Contractor or Builder's Name f Address Electrical Inspection Agency
CONDONS SEPTIC & DRAIN SER
Type of Construction : Septic Alteration Residential Value : S
Plans & Specifications
2000-653
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFF'ICATIONS
S25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Thursday, August 29, 2002
(If a longer period is required, an application for an extension most be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town f OQ shu t
es t 2972000
SIGNER BY for the Town of Queensbury.
Director of Building & Code Enforcement
Application for Permit - Septic Disposal System
Town of Quee►isbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1 . OWNER INFORMATION:
...............___......._..........._._ .... ....................................,..................................
.........
f1' /�+� w �-y�ry fJifice Use
Location of installation: .s-•�C • _. ,r
i Permt No. (�,✓
Tax Map No. I I File
Owner's Name' Fee Paid -.
Address: _ate[ Fes^ cs[
2. IIti[sTALLER'S NAME XiC, 4 AAJ ?_ 98W J!• �HONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate 9 bedroom(s) and multiply # of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of s of Bedr s x u 'on TPIAI Daily Flaw
1980 or older x 150 gal/bdrm = QC3
1980 — 1991 x 130 gal/bdrm
1991 — present x 1 10 gal/bdrm =
Garbage Grinder Installed yes I no
Spa or Whirlpool Installed yes 1 no
Aug
d. PARCEL rNFORMATION: (circle applicable information & indicate measurements)
To V-AUtU y Soil Nature Gerund Water Bedrock pr lenpervious Material D m �c er uppl5r
* a son trt what depth tit what depth mrinlctpal�r
o ing foam Vfeet ,f feet
Steep slope clay ifwell; 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
S. PROPOSED SYSTEM: For NM Construction: All individual sewage disposal systems must be designed by alicensed
professional engineer or architect (unless installed in a Planning Board approved subdivision). Add 250 gallons to the sire
of the septic tank and leach field for each+Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: anon (min, size I, 000 gal.)
Tile Field: each trench ,50 ft. Total System Length.: .a .'�� ft
Seepage Pit(s): number of size ofeach: f1. by fl.
Size of Stone to be used: 11 AS0- / depth or thickness
Bed System Size: x /
Alternative $yytem: length and/or size Wit' -MA :ta,
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.
Sire of responsible person Date
TOWN OF QUEEKSBURY
9 ),30, Jo
,
BUILDING A CODE ENFORCEMENT
742 Bay Road
Queensbury NY I2. 864
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Dame \.
Location [
Date Perrni #
SOIL an oam-Cla Results f Percolation T st-
( if appl able ) Rate- Mi to/ Inch
TYPE OF S STEM:
ABSORPTI FIELD : Total Lengtpr 2�
Length of ch trench 5G�
Depth of tr nche
Size of s ton �F!
SEEPAGE PITS . umbe
Size - ft . ft .
Stone s7ze
PIPING: Size ype
Bldg . to Tank
Tank to !list . Bo
Dist . Box to Fie P ` U
Openings Sealed Yes No Partial
LOCATION/SEP I �-^�
Foundation to ank / feet
Foundation t Absorp ion feet
Separation f' Pits eet
Conforms a per P1 of an No
LOCATION F SYSTEM ON OPERTO'
( circle
Front e - Left Side Right Side
Middle nt - Middle Rea
COMMENTS :
SYSTEM . USE APPROVED: 6YE NO
Arrived :
Departed.:
Building Inspector
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have seen or observed, or believe I saw x 8
rr��Y ti 4
all obJects such as houses, wells, y'� ((� j Y AUG 2 8 2000
sho r, or, this document. I also represent that I batre ( § 2 w:
Aers"ally measured the distances :" _0 '� 8 �
U� t4ft1! the d gram."�
On
SIGNATURE i}A L1J
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