1999-207 • •
Certificate of Compliance
Town of Queensbury
Warren County,New York
Date, May- 5 9 9
This is to certify that work requested to be done as shown by Permit No. _ —__ 9 9207
has been completed.
This structure may be used as a S£PTI
Location 1044. RIDGE. RD. _
Owner
DE VRIES, SUZANNE
By Order Town Board
TAX MAP NO. 5 4 . -1-19 T F QUEENSBURY
at"--, :'='-e----"'""u"'"
Director of Buildin & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY Na 99207
TAX MAP NO. 54 . -1-19 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to DE VRIES, SUZANNE
OWNER of property located at 1044 RIDGE RD. Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC AI TERATI.ON
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNERS Address is
1044 RIDGE RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
CROMWELL, CHRIS
3. CONTRACTOR or BUILDER'S Address
80 CLOTHIER ROAD
CORINTH, NY 12822
4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by XI
SEPTIC
( )Wood Frame ( I Masonry ( I Steel ( 1
7. PLANS and Specifications
SEPTI6o.ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
$ 25 PERMIT FEE PAID —THIS PERMIT EXPIRES May 3 192001
(it a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
3 May 1999
Dated at the Town of Queensbury this Day of
19
SIGNED BY for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept. of Community Development Permit No. r-i t o)
Building &Codes Office
742 Bay Road Fee Paid SO •
Queensbury, NY 128(34
J
Location of property for installation: 1 Uri OC�� lc�✓�
Property Owner's Name: Sit Di.j
Property Owner's Mailing Address: 1 T L-t CI (LID G,_- L
-4-70
Installer's Name: . S' kc-T7 - Phone # b 5 G/-9 E° cf
Number of bedrooms (if residential): 2— Total daily flow:
(residential -compute @ 1 , rit)ilt
Topography: ✓flat, rolling, steep slope 90 of slope APR
Soil Nature: sand, t/loam clay, ,a°14 F 1999
other Idepth:
��„ �< '- SJL3I✓pt:
CODE
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? fief
Percolation test: ✓ not required, required [rate min. per inch
Domestic water supply: municipal, ;�weIl, other
If domestic water supply is a WFT.T , water supply from any septic absorption is feet.
PROPOSED SYSTEM i
Septic tank-/OOV gallon (minimum size: 1,000 gal.)
Tile field: each trench feet / Total system length: / feet
Seepage pit(s): number of / size each: - ft.by ft.
Size of stone to be used: # / depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
Alarm system and associated electrical work to be inspected by a certified agency.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any pew or
awiuval graved 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.
Sin lature of responsible person: Date: Acr,/y�
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name � (//2165
Location �i/ c
Date 5//J`7 Permit # n-207
SOIL TYPE:/// Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total -ngth
Length of each t ench
Depth of trenche•
Size of stone
SEEPAGE PITS: N mbe
Size - . x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Blx
Dist. Box to Fi -ld/Pit
Openings Seale.? Yes No Partial
LOCATION/SEPA' .TIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits _ feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
eioe ,()/94=5.0/e e /ti}Co — \(-
(--(SYSTEM USE APPROVED: YES NO
Arrived: 41
Departed: ililip
Building Insp tor
TOWN OF QUEENSBURY --
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804 el
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
\,) .
Name • I1.9._._,
Location/1)49 RO (Rc
Date 5-T t Permit # c)ce\—a_.37
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: otal ngth
Length of each t ench
Depth of trench s
Size of stone
SEEPAGENITS: mb Nu
Size - - , x ft.
Stone size
PIPING: Size Type
Bldg. to T nk
Tank to , st. Box `fr 5'.p.e 65
Dist. BOY to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation tb Absorption feet
Separation of Pits _ eet
Conforms a per Plot Plan Yes No
LOCATION 0 SYSTEM ON PROPER •
(circle on
Front - Re - Left Side - Right Side
Middle F nt - Middle Rear
COMMENTS:
00—RC 6 4-1= e-—0 K
Ai' ' V;00014
/Nsm-C.c._ I?P Cee..//U 'tQ
10PA ver 19 1t-,-
SYSTEM USE APPROVED: YES N
Arrived: 2„try5„--
Departed:
Building Inspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name _, `'
Y
Location j 1 6 c-
Da CAC) -j-07
) Pniijt #
S IL YPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: otal Le th
Length of each rench
Depth ppf tre hes
Size of t e
SEEPAGE P . -N umb_e
Size - ft. x ft.
Sto size
ING: S ' e Type
Bldg. to Tank " 35---
Tank to Dist. Box
Dist. Box to Field/Pi
Openings Sealed? - No Partial
LOCATION/SEPARATIONS.
Foundation to Tank /2.-- feet
Foundation to Absorption feet
Separation of Pits _ eet
Conforms as per Plot Plan 40 No
LOCATION OF SYSTEM ON PROPER .
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
( IZ774 :
-14^)l 4-Pc r 0/tiL C
1AJL6,j /9/0- - 0K
SYSTEM USE APPROVED: YES ;5)
Arrived:
Departed:
-1/71v
Building Inspector
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 6.; -/ l
Location • ` Opa
Date . Permit #
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS Number-
Size - ft. x ft.
Stone size
PIPING: Sizfr Type
B g to Tank
ank to Dist. Box
Dist. Box to Fiel ' /Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARAT ONS:
Foundation to Ta k feet
Foundation to Ab.orption feet
Separation of Pi s feet
Conforms as per 'lot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
PcCIY
itt(— R -CikcC1(
SYSTEM USE APPROVED: YES 0
Arrived: °
Departed: =��(-�
Building Inspector
Devries
54.-1-20 \Th istl ewoc
54.-7-31
54.-7-3
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will (Oki._. ._‹), .-lk
ow ,
1" ) ,600 6„,k__ .
)0 ` vox) I :AK eP k T ®NAY
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ilill
_ _
54.-1-18
54 -3-4 1 A
SCALE: One Inch Represents100 Feet N
Produced by the Town of Queensbury, NY, Planning Department a
03/03/1999 1, /— ,0 1 9
BEk
TOWN 3 ¢S E E U RY MAR t 1999
i TOWN 0d..Jr r. S e*inv
I LD l a J & (-0D—X), PT. BUI .ING.AND • 'DL
REVIEWED EY _ r G - ` ^'
DATE f?