2009-582 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (318) 761-8256
C�E IVLI F I C AT E (03F" C0M P L I AN IE
Permit Number. P20090582 Date Issued: Wednesday, December 08, 2010
This is to certify that work requested to be done as shown by Permit Number P20090582
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:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DUES NOT relieve the *2'e. r'
property owner of the responsibility for compliance with Site Plan, `'�" .ri
Variance, r th r i sues and condition a s result of approvals the o other s s sby Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090582 Application Number. A20090582
Tax Map No: 523400-297-010-0001-052-000-0000
Permission is hereby granted to: ALEX ALEXANDER
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
QUEENSBURY, NY 12804-0000 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2009-582
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,December 01, 2010
(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 Trn olee ecember 01,2009
SIGNED BYr a ; > for the Town of Queensbury.
Director of Building&Code Enforcement
For an EPA homeowner's guide: http//www epa gov/npdes/pubs/homeowner auice ce�sfmizpdf`; r
------------------------- -------------------� t
29 F010- OFFICE USE ONLY
TAX MAP NO. PERMIT NO. 0 -VSaERMIT FEE
i u
APPROVALS: ZONING TOWN CLERK
-- -
-----------------------------------------
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PE��.� .. .,.N
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER: Alex and Linda Alexander INSTALLER:
ADDRESS: 667 Ridge Road ADDRESS:
PHONE NOS. 792-4917 PHONE NOS.
LOCATION OF INSTALLATION: 667 Ridge Road
_ RESIDENCE
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW INFORMATION:
BEDROOMS
1980 or older Q X 150 gallon per bedroom = Q GARBAGE GRINDER
INSTALLED? NO
1981 -1991 Q X 130 gallon per bedroom = 0
1992-present X 110 gallon per bedroom = 330 SPA OR HOT TUB
® INSTALLED? No
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING X STEEP SLOPE SLOPE_ 0 %
✓ SOIL NATURE: SAND—X LOAM X CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?16"-22"± BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTI¢�IVAT SUPLY:
MUNICIPAL X LL_ (If well:water supply from any septic system absorption is:L
✓ PERCOLATION TEST: RATE IS 4min36sec PER MIINUTE PER INCH(TEST TO BE COMPLETED BY A LICENSED
PROFESSIONAL ENGINEER OR ARCHITECT)
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).
TANK SIZE: 1000 GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
each garbage grinder, spa or whirlpool tub.
SYSTEM TYPE:
❑ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X
❑SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
®ALTERNATIVE SYSTEM Bed orothertype? Mound system w/12' x 54' absorption bed
❑HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL
INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
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 th - gulation ith respect to this application and agree QUESTIONS? CALL 761-8256 OR EMAIL
to abide by t ' and all r uirements,07pe Town of Queensbury codes(cDpueensbury.net
Sanitary S g Disp I rdinance VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensbury.net
�t 12-G 01)/
Si_a re of Perso Responsible D to
Town of Qiteensbttry• Community Development Office • 742 Bay Roach, Qtteensbttry, NY 12804
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: amlom Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: �, G .���/ PERMIT NO..
LOCATION: INSPECT ON: /
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/Clay
Type of Water: Municipal Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' +/ - Y N N/A
150'to well required if NO
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
End Cap Y N
Isle Outlet Pipes&Baffles Y N
Manholes 12"or less below grade _Y!N
[provide extension collar if Yes Y N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.—
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
ETU Maintenance Contract Y_ N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
stem Use S tus:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection ReporiiO3 2910.doc
rL
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Prart: s j4I am/pm
742 Bay Rd.,Queensbury, NY 12804 Inspector's Initials: '
f l'
NAME: PERMIT NO.:
LOCATION: '_ ` _ INSPECT ON:
RECHECK:
Comments and/or diagram
Soil T Sand J Loam Clay
Type of Water: Municipal Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' +/-
150'to well required If NO
Absoi!on r Field: Total length
ft.
ie
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 ��`' r'r '✓�-,
End Cap Y N
Inlet/Outlet Pipes&Baffles Y N
Manholes 12"or less below grade N c �a
[provide extension collar if Yes Y N
Location Separations ---
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan _Y_N
Engineer Report and As-Built _Y_N
ETU Maintenance Contract Y+N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
Pproved
P l Approved and needs to be reinspected, please call the Building&Codes Office
Dkilapproved
LAPam Whiii��W Building Codes Forms\Inspectlon Forms\5eptic inspection Repat_O3 2910.doc
JARRETT Engineers, PLLC Civil&Environmental Engineering
TRANSMITTAL
To: Town of Queensbury Building&Codes
742 Bay Road
Queensbury,NY 12804
Date: November 23,2009
Re: Alexander Wastewater
JE 04-091
ITEMS TRANSMITTED
!2uantitv Description
1 Application for Septic Disposal System Permit
11 by 17 drawings entitled "Replacement Wastewater Leaching System
Alex and Linda Alexander"
Property Plan—CI
2 Wastewater Plan—C2
Sanitary Details—DI
Erosion&Sediment Controls—ECI
Revision D, dated 11123109
COMMENTS:
For approval and permit.
If you have any questions, do not hesitate to contact me at(518) 792-2907.
Sincerely,
JARRETT Enpneers, PLLC
Florene Thornton
Office Administrator
Enc.
CC: Alex Alexander
F IDataFile12004 Project Files0004 Residential ProjecW 04-091 Alexander Wastewater120081E SubmissionslDrafts104091091008 Rev D
Replacement WW System(Q'bury)LSource FilesW4091 091123 WW Appl Submittal.doc
12 East Washington Street 518 792-2907
Glens Falls,NY 12801 Fax 518 798-1864
(R)-...s
TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY 12804-5902 518-761-8201
December 1,2010
Alex Alexander
667 Ridge Road
Queensbury, NY 12804
Dear Mr.Alexander.
Charles Dyer, Building Inspector for the Town of Queensbury, has tried to close out a sewage
alteration permit that was issued to you on December 1, 2009.
It is my understanding that Mr. Dyer met with your wife who stated that some work had been
done on the system, but refused to offer any details about what had been done or who had done
the work.
This letter is to notify you that it is illegal to modify your septic system and use it without any
inspections by this office, and this would be a violation of Chapter 136 of your Local Town Code.
I'm asking that you contact me upon receipt of this letter so that we can ascertain what work was
done on the system and provide the necessary inspections, or have the person who did the work
contact us to verify what was done, in order to close out this permit.
Failure to do so would result in a court summons being issued if this matter is not taken care of
by January 1, 2011. Thank you for your anticipated cooperation.
Sincerely,
TOWN OF QUEENSBURY
David Hatin, Director
Building and Code Enforcement
DH/mg
"HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE"
■ Complete items 1,2,and 3.Also complete A Si
item 4 if Restricted Delivery is desired. ❑Agent
■ Print your name and address on the reverse ❑Addressee
so that we can return the card to you. B. Received by(Print Name) C. Date of Delivery
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
D. Is delivery address different from item 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: ❑No
Alex Alexander
667 Ridge Road 3. se ceType
Queensbury, NY 12804 0 Certified Mail ❑Express Mail
❑Registered ❑Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number 7005 0390 0002 9053 4944
(rnensfer from service 1a1e0
PS Form 3811.February 9nnd _ ^-•- -
UNITED STATES POSTAL SERVICE First-Class Mail
Postage&Fees Paid
USPS
Permit No.G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
TOWN OF QUEENSBURY
BUILDING AND CODE ENFORCEMENT
742 BAY ROAD
QUEENSBURY NY 12804
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