2001-378 ._ TOWN OF QUEENSBURY
742 Ba Road ueensbu NY 12804-5902 518 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010378 Date Issued: Friday, June 08, 2001
This is to certify that work requested to be done as shown by Permit Number P20010378
has been completed.
Tax Map Number: 523400-290-006-0001-068-000-0000
Location: 1104 RIDGE Rd
Owner: WILLIAM & TAMMY WHITTY
Applicant: WILLIAM & TAMMY WHITTY
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
(DJ
Director of Building& Code Enforcement
4�` TOWN OF QUEENSBURY
tors 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010378 Application Number: A20010378
Tax Map No: 523400-054-000-0001-022-000-0000
Permission is hereby granted to: WILLIAM & TAMMY WHITTY
For property located at: 1104 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: WILLIAM& TAMMY WHITTY Septic Alteration Residential
1104 RIDGE Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
OUEENSBURY SEWER
JAY SWEET
Plans & Specifications
2001-378
SEPTIC ALTERATION AS PER APPLICATION
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Sunday,June 08,2003
(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 To o eens ry• F ' :y,i une 08,2001
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SIGNED BY +84/
/''" for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System
Town of Qtteenshtny 742 flay Road Queensbury, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
�:'�� " Office Use
Location of installation: e
File Permit Not:20 I-37g
Tax Map No. / / U
Owner's Name: / ; c ;l (i ,�) ', j ,Fee Paid
as.
Address: c , c�! e �°e "I
2. INSTALLER'S NAME
<C �c �✓r d�
r1,,\ PHONE NO. 7 q ,_, ' t
3. RESIDENCE INFORMATION: (circle year of dv(elling, indicate#bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1 .3 x 150 gal/bdrm _ 1 '
1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm = RECEIVED
Garbage Grinder Installed yes— / o, J U N 0 5 2 0 01
Spa or Whirlpool Installed yes / no
TOWN OF O EE S[F `t
BUILDING AND CEO;zF
4. PARCEL INFORMATION: (circle applicable information&indicate measurements) - -�
T =ra h Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
1'inv "4E9%'/77 at what depth at what depth municipal
Rolling loam feet feet well
Steep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is i ft.
other •
Percolation Test: (7b be completed by licensed professional engineer or architect)
• Rate: minute per inch
5. 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). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank:/t--z) gallon (min. size 1,000 gal)
Tile Field: each trench f? Total System Length: ft.
Seepage Pit(s): number of size of each: ft. by_ ft. : .,,
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
Alternative System:/ t'I ,fi f fry length and/or size , 672 .
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.
w.c
ur of responsib e person Date
TOWN OF QUEENSBURY
BUILDING_ & CODE ENFORCEMEN
742 Bay Road
Queensbury NY 1280�1- ''y`"
(518) 761 8256 �
SEPTIC DISPOSAL SYSTEM INSPECTION
/
Name llih e'rhr.
Location // i 4 it 9. I
pjktt- it .0 / 13/
SOIL TYPE: Sand-Loam Clay-
Results of Percolation Test-
(if applicable) - Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIEL': Tota Lentil ceuu
Length of each rench0 51)
Depth of trenche. Z
Size of stone c ll.-VA:'(DU2_
SEEPAGE PITS: N •er- )
Size - ft. x / ft.
Stone size
PIPING: S'z�g Type
Bldg. to Tank
Tank to Dist. 8o`x as /. 2-()
Dist. Box to Field/P. .1 �S
Openings Sealed? 41 No Partial
LOCATION/SEPARATI' .
Foundation to Tank a feet
Foundation to Absorption et
Separation of Pits fe t
-F-- Conforms as per Plot Pla Yes o
LOCATION OF SYSTEM ON PRIPE .
(circle one)
Front - Rear - , eft Sid- - Right Side
Middle Front - Mi.. - 'ear
COMMENTS:
4— utc._7
SYSTEM USE APPROVED: YES NO
Arrived: /3re ,
Departed:
Building Inspector
"I have seen or observed, or believe l saw evidence of, f'
all objects such as houses, wells,trees,fences, etc., C
shown on this document. I also represent that I have
personally measured t distances set forth on the diagram."
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IGNATURE DATE I
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04 2 ? F :.
juN 0 5 2001
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TOWN OF CU=ENSBURY j
BUILOtNG AND COOS /
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REVIEWEDi3 .,E- ►r. / f \
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"I have seen or observed,or believe I saw evidence of,
all objects such as houses,wells,trees,fences, etc., 4,
shown on this document. I also represent that I have
personally measured t distances set forth on the diagram."
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IGNATURE DATE
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JUN 0 5 2001
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TOWN OF AND COr3BY
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