2003-653 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20030653 Date Issued: Monday, September 01, 2003
This is to certify that work requested to be done as shown by Permit Number P20030653
has been completed.
Tax Map Number: 523400-297-017-0001-037-000-0000
Location: 445 RIDGE Rd
Owner: JANE NOLAN BARTON & OTHERS
Applicant: JANE NOLAN BARTON & OTHERS
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
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Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030653 Application Number: A20030653
Tax Map No: 523400-297-017-0001-037-000-0000
Permission is hereby granted to: JANE NOLAN BARTON & OTHERS
For property located at: 445 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: JANE NOLAN BARTON& OTHER
445 RIDGE Rd Septic Alteration Residential
Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2003-653
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,August 13,2004
(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 own Que bug; 0/,dnesday,August 13,2003
SIGNED BY11 ♦ �.\ for the Town of Queensbury.
Director of Building&Code Enforcement
Mt ..
Application for Permit—Septic Disposal System S3
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256 /'>
1. OWNER INFORMATION: �!
1"-/I , t'G
't f) ? Office Use
Location of installation: + e /e—,
Tax MapNo. / / File Permit No.
Owner's Name: Fee PaidQ�..)"'`s r
Address: C1-• ie/D& D b .-... ,
r
2. INSTALLER'S NAME : }-�-. la A2 J€( - -A.. /eff-Liic e PHONE NO. �,,4110 ,
3. RESIDENCE INFORMATION: (circle ear of dwelling,indicate#bedroom(s) and multiply#of '`-.0 (°" ?
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older f x 150 gal/bdrm = 17'.. ✓
1980— 1991 x 130 gal/bdrm —
1991 —present x 110 gal/bdrrn —
Garbage Grinder Installed yes / no �j
Spa or Hot Tub Installed yes / no
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
T.-=• aphy So"Irt'ature Ground Water Bedrock r Im ervious Material D tic Water Sunnly
!at sand at what depth at what depth � �—
. ling cam feet feet we
Steep slope clay if well; water supply
�%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test: (To 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 Ieach field for each Garbage Grinder, Spa or Whirlpool Tub.
,1e CP
Septic Tank: i VOL) - -_gallon (min. size 1,000 gal,)
Tile Field: each trench 3.-3 ft. Total System Length: .„7o 0 ft.
N
Seepage Pit(s): number of r l P size of each: ft• by ft.
Size cf Stone to be used: # Ai/ f / depth or thickness feet
Bed System Size: tjI i x
Alternative System: 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 re e regulations wi espect to this application and agree to abide by these and all
requir ents o .he Town of e sbury San"tary Sewage Disposal Ordinance.
aturof responsible person //1`1
i g� e p s�k�te Date
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COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVA1d
Permit No. Cert. 8 U 3 7 8 Cut-in Card No.
Owner
Location
(T4�( S G Z t7
... ...Zy �t"/� c /�
Installation Consisting of.�� e / C i /Am 4�-��
Ai-
Installed By Ti 2,/6 Lic.No.
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall b romptly made for inspection.
Inspectors of this Company shall have the privilege : ma - gin ections at any time, and if its
rules are violated,the Company shall have the right t• r - t s ificate.
Date ✓ ` `-°3 INSPECTOR
Member N.F.P.A.,I.A.E.I.
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/ part: a pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:
NAME: � !� PERMIT NO.: D 4- •
LOCATION: 1��DCvCr INSPECT ON: g 1'f
y'`� (
RECHECK: `
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft•
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size:
Stone Size: 4 ` Al2,y4\
Piping Size Type _
Building to tank PCB�M (-) k 9 1 0',,
Tank to Distribution Box
Distribution Box to Field/Pit
Opening Sealed: Y/N/Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption ft. ` �i
Separation of Pits ft. �✓ 1 /t) e-LE:C .
Conforms as per Plot Plan Y N
Location of System on Property: /4/cP ` 111-1 (63
Front Rear Left Side Right Side �',.�, 5
Middle Front Middle Rear
S stem Use S to
pproved
rtial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
l
/ f10
Septic Inspection Report 3
Office No. (518) 761-8256 Date Inspection request received: • do,
Queensbury Building&Code Enforcement Arrive: am/ i pepart: it _ S 5 am/pm ��
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: lei NAME: PERMIT NO.: 3 j`- "76 3
rJ
LOCATION: y td�� R d INSPECT ON: 3
RECHECK:
Comments and/or diagram
Soil Type: Sa••a• •• Clay
Type ofr a kl/Well Water
Waterline separation distance _ ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench _ 45- ft.
Depth of trenches 1 ft.
Size of Stone IA, F,c-
Seepage Pits: Number
Size:
Stone Size:
Piping Size .e
Building to tank
Tank to Distribution Box 4e/ 4,0 �p
Distribution Box to Field/Pit 11/2-kt �g .f0 I ,J
Opening Sealed NI Partial
5b2 5 Location/Separations
Foundation to tank 4ft.
Foundation to absorptionft.
Separation of Pits ft.
Conforms as per Plot Plan N
Location of System on Property:
Front le Left Side Right Side
Middle Front Middle Rear
System Use Status:
pproved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003