1999-200 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date May 6 19 99
99200
This is to certify that work requested to be done as shown by Permit No.
has been completed.
SEPTIC ALTERATION
. This structure may be used as a
Location 1114 RIDGE RD.
Owner macs, NORMAN & MARIE
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TAX MAP NO. 54 . -1-23 By Order of Town Board
TOWN OF SBU
(j)eit,
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 99200
TAX MAP NO. 54 . -1-23 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to HIMES, NORMAN & MARIE
OWNER of property located at 1114 RIDGE RD. Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC ALTERATION
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. OWNER'S Address is
1114 RIDGE RD.
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
QUEENSBURY SEWER
3. CONTRACTOR or BUILDERS Address
JAY SWEET
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4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X) SEPTIC
)Wood Frame l l Masonry ( )Steel ( )
7. PLANS and Specifications
SEPTdLC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 April 30 2001
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(If 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.)
30 April 1999
Dated at the Town of Queensbury this Day of t9
SIGNED BY Jp.LA1___-_aJfor the Town of Queensbury
Bui i Zoning 1
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept. of Community Development Permit No.
Building &Codes Offic99200
d°
742 Bay Road
Queensbury, NY 12804 9 9 2 00 5 4. -1-2 3
HIMES, NORMAN & MARIE
1114 RIDGE RD.
Location of property for installation: SEPTIC ALTERATION
Property Owner's Name: Afe' /1 n a `C✓ ";' .S -
Property Owner's Mailing Address: c Ct-- S
Installer's Name: r^ ;.� vc- Phone # 7 7- y
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Number of bedrooms (if residential): Total daily flow:
(residential - compute @ 150 gal./bdrm.)
Topography: y flat, rolling, steep slope % of slope
Soil Nature: X sand, Ioam, clay, other /depth: _
Ground water: at what depth? L. feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: \ not recuired, required [rate min. per inch]
Domestic water supply: municipal, \ well, other
If domestic water supply is a WELL, water supply from any septic absorption is/.-Z3 feet.
PROPOSED SYSTEM _
VED
Septic tanker z2' gallon (minimum size: 1,000 sal.)
APR 30
Tile field: each trench h�' feet / Total system length: --' feet 1��9
:1�i6'E4° OF QUEENSSUR`'
Seepage 't s : number offt.by -�� f�a C AND CODE
'Pam Pl( )' / size cacti: . � nv#_,-.,
Size of stone to be used: # / depth or thickness - feet
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HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each.: gznens
(Alarm system and associated electrical work to be inspected by a certified agency.)
For y ots protection, please note that pursuant to Section 136-29 of the Code of the Town of Qoee-.s/////bury, any permit or
apywval era. which is based upon or is panted in reliance rrRterial roisrepresernt6cm or failure to make a
material fact or circumstance known by or on behRlf of an applicant, v11R11 be void.
I have read the regulations with respect to this application and agree to abide by these and all regiments of the Town of
Queensberry Sanitary Sewage Disposal
Signature of responsible person: e t. Date:
//: �"
(T)3 0
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location _ ._ d C�
Date b-40 1C Permit # r\-,z
SOIL TYPE-Sand-Loa -Clay-
Results of Percolation Test-
(if applicable) Rate-M' .ute/Inch
TYPE OF SYSTEM: ,yV/
ABSORPTION FIELD: To ►al L-ngtjl <, JU
Length of each trenc , C5
Depth of tr;nches 1
Size of ston• !!, J
SEEPAGE PITS: Num,' -
Size - ft ft.
Stone size
PIPING: — Size T ype i
Bldg. to Tankr
Tank to Dist. •ox w pa 56
Dist. Box to ield u '4.a ab
Openings Sea ed? I No Partial
LOCATION/SE' .RATION . �}
Foundation o Tank "J'' feet
Foundation to Absorption 60 feet
Separation of Pits feet
Conforms .s per Plot Plan _ 1110, No
LOCATION' SYSTEM ON PROPERT
(circle n4) -
Front - ear - Left Side Right Side
Middle Fron; - Middle Rea
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrived:e ;Q
Departed: �"
Building Inspector
::(7,4
41
TOWN , ,F (7.!'.,.:E:.--2t-',,,:v.:i-::-URY
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REV1EWET.C. BY eiti\X
---71 ,
a) DATE __,,,,/-j, 40,01/71,,,
• 97 -
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RECEIVED
El APR 3 0 7R99
TOWN OF QUEFNS jpv
7 4 9)
(.)
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AIL
"I have seen or observed, or believe I saw evidence of,
\ 1 all objects such as houses, wells,trees,fences, etc.,/-12' shown on this document. I also represent that I have
sonally measured th ista:7forth on the diagram."
/ ,
,
CLISIGNATURE DATE
t)0 1/4.)1
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