SEP-0321-2018 TOWN OF QUEENSBURY
742 Bay Road, Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-0321-2018 Date Issued: Friday, August 10, 2018
This is to certify that work requested to be done as shown by Permit Number SEP-0321-2018
has been completed.
Tax Map Number: 297.14-1-4
Location: 517 RIDGE RD
Owner: Levi Russell
Applicant: Morning Star Excavation& Septic
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the (-7- ,,P I
4,
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
- I
TOWN OF QUEENSBURY
Le
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: SEP-0321-2018
Tax Map No: 297.14-1-4
Permission is hereby granted to: Morning Star Excavation& Septic
For property located at: 517 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
lype of Construction
Owner Name: Levi Russell Septic Disposal-Residential $0.00
Owner Address: 517 Ridge RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Morning Star Excavation&Septic
59 Blanchard RD
Gansevoort,NY 12831
Plans&Specifications
Residential Septic Alteration
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,June 6, 2019
(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 expiratio date.)
Dated at the To of Qu nsbu ; une 6, 2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERM T APP&
ict Use Only
742 Bay Road,Queensbury,NY 1�290 I
Town oft umnsbury 2
P:518-761-8256 www. uee ` bu et JUN 0 2018 `re y
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Tax Map ID#: �� ' I Plermit tee:$ 7 5 ; Invoice#: Q '7
Project Location: 1L Septic Variance? Yes No
Primary Owner(s)
Mailing Address
Phone & Email MI6
Installer/Builder
Mailing Address _ a
Phone & Email �5�� -7�J3 22— Ma ,,`�� i ' ��t � •Cv
Engineer ��, �
Mailing Address
Phone & Email S1
Contact Person for Building&Code Compliance: C ,, Phone:
RESIDENCE INFORMATION:
Year Built Gallons #of bedrooms X gallons per =total daily flow
per day bedroom Garbage Grinder Yes No
1980 or older 150 Installed? (circle one)
1981-1991 130 Spa or Hot Tub Yes No
Installed? (circle one)
1992-Present 110 -3 A0
PARCEL INFORMATION:
Topography Flat Rolling Steep Slope %Slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth? --f- `t
Bedrock/Impervious material At what depth? + 7
Domestic Water Supply J<Municipal _Well (if well,water supply from any septic system absorption is_ft.)
Percolation Test Rate: per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size �gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length ft.; Each Trench ft.
Seepage Pit with#3 stone How many: ;Size:
Alternative System Bed or other type:
Holding Tank System Total required capacity? ;tank size ;#of tanks
NOTES: 1.Alarm system&associated electrical work must be inspected by a Town approved electrical inspection
agency;2. We will no longer allow systems to be covered until such time as an as-built plan is received and approved.
The installed system must match the septic layout on file—no exceptions.
Declaration:Any permit or approval granted which is based upon or is granted in reliance upon any material
representation 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 and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage
Disposal Ordinance.
PRINT NAME: Q_r DATE:
SIGNATUR . DATE: ��
Town of Queensbury Building&Code Enforcement Revised March 2018
517 Ridge Rd - Google Maps Page 1 of 2
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LEVI RUSSELL SEPTIC SYSTEM R CIJ f8 2018 D� `bvf R1x,
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- ENSBUR
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SEPTIC PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS Imagery 02018 Google,Map data 02018 Google 50 ft
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
WN ON THIS DOCUMENT.I HAVE PERSONALLY
M SURED THE DISTANCE SET FORTH ON THI DIAGRAM,
TOWN OF QU _
SIGNATUR - DA
BUILDING &
Reviewed By
Date:
https://www.google.com/maps/place/517+Ridge+Rd,+Queensbury,+NY+12804/@43.340521,-73.6305762,136m/data=!3ml!1 e3!4m5!3m4!lsOx89dfd0... 6/5/2018
KEVIN L. HASTINGS, P.E.
CONSULTING ENGINEER
Mailing Address: 3 Jackson Avenue
South Glens Falls;New York 12803
Tel: (518)222-1338
June 13, 2018
Mr. John O'Brien
Building Inspector
Town of Queensbury
742 Bay Road
Queensbury,New York 12804
Re: Sewage Disposal System-Engineer's Certification
517 Ridge Road
Dear John,
The construction of a replacement sewage disposal system for the residence at 517 Ridge Road
(TM#297.14-1-4)has been completed. The installation was completed by Lou DeRidder of
Morning Star Septic Service,who was also present for the final inspection.
As the design professional of record,I certify to the following statements:
1. Engineering design report with specifications and details were prepared June 4, 2018 by
Kevin L.Hastings,PE for a 3 bedroom maximum(330 gpd) single family residence;
2. Design documents were compliant with the Town sanitary health codes, and the NYS
Health Department Appendix 75-A, as applicable;
3. Field observation of constructed works on June 13,2018,by Kevin L. Hastings,PE and
prior to earth backfill of trenches and structures;
4. Completion of the work appeared to be in substantial conformance with the design
engineering report,with the following exceptions:
- final turf stabilization&lawn maintenance to be completed in 2018 by owner.
The as-built schematic of the replacement sewage disposal system with location ties to the
dwelling is attached for your records. .
If you have any questions or require additional information,please contact me immediately.
Sincerely,
te:44444.
- AS BUILT
Kevin L.Hastings,PE
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KEVIN L. HASTINGS PE
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3 JACKSON AVENUE
SO. GLENS FALLS, NY 12803
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— KEVIN L. HA STINGS, PE
3 JACKSON AVENUE
SO. GLENS FALLS, NY 12803
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SO. GLENS FALLS, NY 12303
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KEVIN L. HASTINGS, PE
3 JACKSON AVENUE
SO. GLENS FALLS, NY 12803