2004-211 _41_1140! TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
411
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20040211 Date Issued: Thursday, April 22, 2004
This is to certify that work requested to be done as shown by Permit Number P20040211
has been completed.
Tax Map Number: 523400-279-000-0001-039-000-0000
Location: 1295 RIDGE Rd
Owner: WILLIAM & RUTH AIKEN
Applicant: WILLIAM & RUTH AIKEN
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
rThi s „01
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
vico 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040211 Application Number: A20040211
Tax Map No: 523400-279-000-0001-039-000-0000
Permission is hereby granted to: WTT,T,TAM&RI TTH ATKF,N
For property located at: 1295 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&RUTH AIKEN
1295 RIDGE Rd Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2004-211
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, April 21, 2005
(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 Town df Queenjiff
• Wednesday,April 21, 2004
SIGNED BY / . for the Town of Queensbury.
Director of Building& ' ••- \!rcement
Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Location of installatioi 27J 2t'c 2 J Office Use
Tax Map No. / / File Permit No. I
Owner's Name: 6,„ i A Fee Paid S o?C)
e,
Address: t /c 9 i2 ;) 2)
2. INSTALLER'S NAME : s,S SC/,-; C PHONE NO. 7p9f—k/
3. RESIDENCE INFORMATION: (circle year of dwelling,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
1980 or older3 x 150 gal/bdrm = S 0 i .-"-,.
1980— 1991 x 130 gallbdrm = ):,,,a -
1991 —present
x 110 gal/bdrm =
Garbage Grinder Installed yes / no `'',
Spa or Hot Tub Installed yes / no ;?`1
e�`
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
aphy ' ature Ground Water Bedrock or Impervious Material Domestic Water Supply
Flat sand at what depth at w at depth ' i al
'• ling am l ,� , P
Steep slope clay —yet feet ell
_%slope other dwell; water supply
depth: from any septic-system
absorption is Aft. ft.-1'
Percolation Test: (To be completed by licensed professional engineer or architect) other
Rate: I—4 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: /Do a gallon (min. size 1,000 gal)
Tile Field: each trench ft. 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
i
Bed System Size: x
''J'' Z I
Alternative System: 6 , J 1 '" �n'���length and/or size
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 T
c-4-- /--ao �of Queensbury Sanitary Sewage Disposal Ordinance.
V r ,i 4 /e
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ignature of responsible person Date
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Septic Inspection Report
Office No. (518) 761-8256
Queensbury Building&Code Enforcement Date Inspection re• st rec=ive.
Arrive:742 Bay Rd., Queensb pm .
ry, NY 12804 Inspector's Initials. a m�
NAME:
LOCATION: `\' £TON:
Soil T� �� Comments and/or dia ram
TA.e of Wa e7-•,mac; ::
Waterline separation dis . J
allinalfM
Well separation distance
Other wells: t ft.-1—
Abso .tion Field: Total len_ h -- - eft'
Len: h of each trench �,�-ft+�■.
De.th of trenches
Size of Stone
See.a: r
e Pits: Number
Stone Size:
11.11111.1111111
Buildin_ to tank 111
Size ��_ r
Tank to Distribution Boxt.
Distribution Box to field/Pit Emingimignm
O.ening Seale. Partial _.
111.111111111
Location/Se.arations .
111111111111
Foundation to tank agril
Foundation to abso .tiona
Se.aration of Pits
Conforms as .er Plot Plan
Location of System on Property;
Front Rear eft Side fight Side
Middle Front Middle Rear
S stem Use S tus•
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
L:'SueHemingway1Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
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