2002-514 TOWN OF QUEENSBURY
742 BayRoad,Queensbu ,NY 12804-5902 (518)761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20020514 Date Issued: Friday, June 21, 2002
This is to certify that work requested to be done as shown by Permit Number P20020514
has been completed.
Tax Map Number: 523400-297-007-0001-032-000-0000
Location: 710 RIDGE Rd
Owner: CYNTHIA EVANS
Applicant: CYNTHIA EVANS
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
AT 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: P20020514 Application Number: A20020514
Tax Map No: 523400-297-007-0001-032-000-0000
Permission is hereby granted to: CYNTHIA EVANS
For property located at: 710 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: CYNTHIA EVANS
710 RIDGE Rd Septic Alteration Residential
Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
OIIEENSBIIRY SEWER
NY 12804-0000
Plans&Specifications
BP 2002-514
Septic alteration as per plot plan and specifications
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,June 21,2003
(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 of Queensbury; Friday,J ne 21,2002
SIGNED BY If°'" 4"9 4
! / for the Town of Queensbury.
Director of Building&Code E orcem t
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 RprPI vED
1. OWNER INFORMATION: Office $ `) O°Z ,
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Location of installation: Ti/(' 4 (C1_..f-C. c_
tZ))' .. '7
(;'� File Permit o. A-01 c0
Tax Map No. /.. 1/7? 1 -
Fee Paid
Owner's Name: ,? r -cti 1. ci
Address: / I.,. k sj .E- -c
2. INSTALLER'S NAME :C--c,7*NiL. 'E_c_..4,QA§1�. c 3-..---v .
PHONE NO. / 7JK
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.' • 2 x 150 gal/bdrm = .� ``'
1980—1991 x 130 gal/bdrm = O '✓
1991 —present x 110 gal/bdrm = /'.
)27-
i ,...7
s. ickt
Garbage Grinder Installed yes_ / , j✓ I
no
1
Spa or Whirlpool Installed es / no.. t e)
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4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
sand at what depth at what depth municipal
o ing feet feet we
Steep slope i well;water supply
_%slope other from any septic-system
depth: absorption is/Q v 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 leach field for each Garbage Grinder,Spa or Whirlpool Tub.
Septic Tan-•
\-i/ -7'•.)gallon(min. size 1,000 gal)
Tile Field: each trench ,3 G ft. Total System Length: ,r ! ft.
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
r
Alternative System:, t9--Ir /t r 4 length and/or size q
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 Town of Queensbury Sanitary Sewage Disposal Ordinance.
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Si a r of responsible person Date
1 g'9
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 601Aji/S
Location 2 0Ca6-- , -
Date 2 D2- it , it # /9 Z'
SOIL TYPE: Sa :-Loan°-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION F 1. otal Let _
Length of ea tren, h / Z
Depth of tren es
Size of stone i 7-RA-rot
SEEPAGE PITS: N'iber
Size - ft. x ft.
Stone size
PIPING: Size TyRe
Bldg. to Tank / j/.
Tank to Dist. Box ' 6xi 2
Dist. Box to Field/Pit k H
Openings Sealed? e No Partial
LOCATION/SEPARATION .
Foundation to Tank feet
Foundation to Absorption ) feet ,
Separation of Pits eet
Conforms as per Plot Plan -�-�✓' No
LOCATION OF SYSTEM ON PROPERTY:
(circle e...-
Front - Re. ' - Left Side - Right Side
Middle • t - Middle Rear
COMMENTS:
SYSTEM USE APPROVED: YES NO
Arrived:
Departed: :FLY; dvy
Building Inspector
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