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2000-522 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 O Community Development- Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20000522 Application Number: A20000539 Tax Map No: 523400-059-000-0003-011-000-0000 Permission is hereby granted to: CATHLEEN CANTIELLO Owner of property located at: 463 RIDGE Rd in the Town of Queensbury, to construct or place a Septic Alteration Residential 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. Owner Address: CATHLEEN CANTIELLO 463 RIDGE Rd QUEENSBURY,NY 12804 • Contractor or Builder's Name/ Address Electrical Inspection Agency I.B.S. SEPTIC 2 LOWER WARREN STREET OUEENSBURY,NY Type of Construction: Septic Alteration Residential Value : $ Plans &Specifications $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,July 24,2002 (If a bnger 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 o Toie;r2b,y; o ay,July 24,2000 SIGNED BY for the Town of Queensbury. Director of Building& Code Enforcement Application for Permit—Septic Disposal System Town of Queensbuty 742 Bay Road Queensbury, NY 12804 (518) 761-8256 1. OWNER INFORMATION: 1 Office Use Location of installation: 6) r\/ �(C /` �.0c�7� `J File Permit N `S Tax Map No. / / �-- Fee Paid Owner's Name: 711 , kc ay /C_ U Address: -# V6 ? r, j c A d l 2. INSTALLER'S NAME : J . . 8 , s, S0 / ,, 6.-- PHONE NO.7`7t—u1 P i� 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 older x 150 gal/bdrm = V f --c) ' -: - '-• 1980— 1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = j11L if . a Garbage Grinder Installed yes / no ...— Spa or Whirlpool Installed yes_ / no 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) raphy S% ,ture Ground Water Bedrock or Im ervio s Material _ ' Water Supper an. at�hdepth at �— epth municipal e�ling wain feel feet Steep slope clay if well; water supply __%slope other from any septic-system depth: absorption is ft. other Percolation Testy o 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: /00 0 gallon(min. size 1,000 gal.) 1 �,A/ /; i / to !0 l Tile Field: each trench S d ft. Total System Length:p/-Q 0 ft. Seepage Pit(s): number of size of each: ft. by ft. Size of Stone to be used: # // A_ / depth or thickness feet Bed System Size: 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 read the regulations with respect to this application and agree to abide by these and all requirements of the To of Queensbury Sanitary Sewage Disposal Ordinance. 22, r 7-d- V.---)aw gnature of respon le on Date T� OF EE1l5BlfRY 01FORC'EW"T BI jLDINfs ?42 Bay Road queenst�ury_ M� 4 (Slg) 751-9756 SEPTIC GISpOSAL SYSTEM IN5PECTIC)!C Name Location — '" it #� Perms Date _ SOIL TYP ion Test- Results of ercol a .-Mi nute/ Inch _fi- ( i f appl i ca le Rat TYPE pF SYS F Tot 1 j4th ABSORPTI0" trench Length of ea Depth of tree hes � ► Size of stone um er- ft . SEEPAGE PITS x Size - _ _---..� Size e,. - Stone size _�- - PIPIxG: k �, Bldg . to Tank Tank to Dist . Box - ~ Dist * Box to Field/P Q arty a open-, Sealed? Ye feet OCATIOWSEPARATIC H feet Foundation to Tank ti ort to Absorp eet Foundation f Pits Yes No Separation o er Plot Plan Con forms as SYSTE14 Lm PRCfPER61 LOCATION _ Right Side ( circle ea _ Left Side Front - .. t4i ddl e Rear Mi ddl e F COTS SYSTEM USE APPRDVEQi Ons No 'Depar to U� a�-ted . �. Building Inspector if: A G. l,n v v , "I hay seen or observed, or believe I saw evidence of, TOWN OF QU ENS: RY all obi c.ts :Lich ls. t�:,uses, wells, trees, fences, etc., shov,if r1 this dOci nt. i aiso represent that I have BUILDING & ♦ . ''T �a( persun q measured the d. lances set forth on the diagram." REVIEWED B A .•�/ ten' I 2-42/ 1/ DATE o v 4/ SIG DATE 4/ C t v' �� 1 I3 ) , ijouSt ',v j i.`\ r \u 6.J.) te /.'1 .64Lc1 11c (la q63 n:I c, 1-01 ©f,tC A.,S6u^,› v k