96-606 CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date October 7 19 96
This is to certify that work requested to be done as shown by Permit No. 96606
has been completed.
This structure may be used as a SEPTIC ALTERATION
Location 1571 RIDGE RD.
Owner GODDARD, ED%ARD & EMILY
By Order of Town Board
`.PAX HAP NO . 27 . - 1-21 c TOWN F q UR
f
Director of Building & Code Enforcement
BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No 9GGOG
TAX MAP NO. 27 . —1-21 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to_ GODDARD, EDWARD & F.MIL-Y
OWNER of property located at
1571 RIDGE RD. Street,Road or Ave.
in the Town of Queensbury,To Construct or place a SEPTIC M TF>Z-nT'TON
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
1571 RIDGE ROAD
QUEENSBURY, NY 12804
2. CONTRACTOR or BUILDER'S Name
MARCILLE, RICHARD
3. CONTRACTOR or BUILDER'S Address
RAM TRANSPORT
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC
( )Wood Frame ( ) Masonry ( )Steel ( 1
7. PLANS and Specifications
SEP'C ALTERATION AS PER APPLICATION
8. Proposed Use
SEPTIC ALTERATION
25 September 2619 48
$ PERMIT FEE PAID —THIS PERMIT EXPIRES
(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.)
2 6Day of September 19 96
Dated at the Town of Queensbury this
SIGNED BY for the Town of Queensbury
Building and Zoni Inspector
Application for SEPTIC DISPOSAL PERMIT 1 O
STAMP RECEIVED Z
Location ofproperly fur installation: /5-7/ " ,c Rd u," O
Owner's Name �jwetvel # 6'o6741� e ltMlI'NO llllili 'v
IS7/ IPrjyQ RI Qveens-4u�y -�0
Owner's Mailing Address: / /
by iss�y i n'1
FEEFEEPAID C J / —
Z
Installer's Name: RrCII"r' flavtefie Phone #: —�_ V)
I"
Number of bedrooms (if residential):
sEP 2 419 * 1-C
Goo
Total daily Ilow (residential -compute 0 I50 gal. per bedroom):
Topography: r -1 flat �G Rolling r---i Steep Slope gb of Slope„
Soil Nature: n Sand M Loam FM Clay Other /Depth:
Ground Water: at what depth? feet
Bedrock or Impervious Material: at what depth? 0 feet
Percolation Test: (-1 Not Rednired r- Required/Rate min. per inch
Domestic Water Supply: Q Municipal Well I-1 Other
If domestic water supply is a WELL: water supply from any septic absorption is feet
PRUI'OSlil) SYSTEM: r
_
r5/t
Septic tank: 1000 gal, (minimum size: I.000 gal.)
Ti Field: each trench `� v feet. / total system length a feet.
Seepage Pit(s): number of `�v / size each: ft. x ft.
✓Size of stone to he used: # / depth or thickness 1 • feet.
IIOLDING TANK SYSTEM: (if required)
•
Number of tanks: • Size of each: gal. •
Alarm system and associated electrical work to be inspected by a certified agency.
For your prorection, 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 fret or circumstance known by or on
behalf o fan 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 Qrceensbury.Sanitary Sewage Disposal Ordinance.
Signature of responsib-e person: Date:
TOWN OF QUEENSBURY
BUILDING 5 CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
NamesA...
Location J 5'2/ £%
(11r Date /0/44 Permit # 10(i)
SOIL TYPE: Sand-(,oam lay-
Results of Percol ' ion Test-
(if applicable) ate-Minute/Inch
TYPE OF SYSTE
ABSORPTION FJ.tLD: 'Fatal Length 7 ,t
Length of each trench �Ca.:_522
Depth of trenches vistt 2-4`+
Size of stone .�
SEEPAGE PITS: Number-
Size - f t: --#t.
Stone size .�—��
PIPING: Size Type .
Bldg. to Tank
Tank to Dist. Box
4%`
Dist. Box to Field/P ' ►i 'Jc_.
Openings Sealed? ► o Partia
LOCATION/SEPARATI'i
Foundation to Tank 6051a&eet
Foundation to Absorption j feet
Separation of Pits ---- feet
Conforms as per Plot Plan No
LOCATION OF SYSTEM ON PROPERAY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Fron ; d
COMMENTS:
SYSTEM USE APPROVED: (::: :=7
::: J!:O
Arrived- P
iA
Depar ed _,l _
:uildin, •pector
L//
TOWN CF QUEENSBURY
BUILDING & Cti►E ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 614U
Location /r?/ E� e
Date �t/•4''f‘; Permit # Pam /)(
SOIL TYPE: Sand-L am-Clay- .
I P
Results of Percola i Test-
(if applicable) Rat -Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD• To al Length
Length of each rench
Depth of tren es
Size of stone
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Fit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
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:
4)e 01JeC -Cr i at.6
SYSTEM USE APPROVED: YES NO
Arrived: /0
Departed:
Building nspector
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