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2004-963 4 TOWN OF QUIE E NSB URY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20040963 Date Issued: Wednesday, December 15, 2004 This is to certify that work requested to be done as shown by Permit Number P20040963 has been completed. Tax Map Number: 523400-297-007-0001-001-001-0000 Location: 766 RIDGE Rd Owner: DAVID & KATHY CERNY Applicant DAVID & KATHY CERNY This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY ( 4tOP 1/ Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040963 Application Number: A20040963 Tax Map No: 523400-297-007-0001-001-001-0000 Permission is hereby granted to: DAVID & KATHY CERNY For property located at: 766 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: DAVID &KATHY CERNY 766 RIDGE Rd Septic Alteration Residential Total Value QUEENSBURY, NY 12804-0000 Contractor or Builder's Name /Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans&Specifications 2004-963 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, December 15, 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 eensbury Wed esday, December 15, 2004 SIGNED BY • for the Town of Queensbury. Director of Building& e En cement Application for Permit-Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: �J Q Office Use Location of installation: 7l/a O\ File Permit No. 0 90_3 Tax Map No. / / Owner's Name:Th A V 111- (- CEP-, I Fee Paid Q � Address: 7 (.:, ( fe t e_ Vre. 2. INSTALLER'S NAME : N v1�(4rt) PHONE NO. 7(:;1'5 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 J x 150 gal/bdrm = VWCEI J 1980 1991 x 130 gal/bdrm = v �� 1991 —present x 110 gal/bdrm = DEC 4 2004 Garbage Grinder Installed yes / no TOWN OF QJEENSgU Spa or Hot Tub Installed yes_ / no AND COD RY 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) Topography So' ature Ground Water Bedrock or Impervious Material Domestic Water Supply at sand- at what depth at what depth munic' Rolling loam feet feet well 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 IDS paw 16 .1 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: 10 0 gallon (min. size 1,000 gal) AS Pet- PLIffilf Tile Field: each trench c.51C ft. Total System Length: 220 ft. ti7/e. s( Li`� ' 2 20 Seepage Pit(s): number of All 4 size of each: ft. by ft. Size of Stone to be used: # / 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 require = - Town o ueen Sanitary Sew e Disposal Ordinance. ign• e of responsib 'person ate • jiinh S(` ver :tad Sc v;t1CC Disposal l Chapter Appin»(li x (: i • ' A1314()ILI'''1'I()N IN I UJI) . . SE PA It:FAIL/IILI N1li:t4'1'$ �•�•..� gyp;•...... /) Ili \'HrPivi ., (• ) rPOND ..\ 1rlEtt_ tN %rMt*'tk• rt u'►a•t . •trt ttr Witt; -�`• / ...'"*. yr / • y '' ram• ✓' - •T aC G ( t1g. /31: • •• llovs_ G . . E • • t>- g:-. `..`. . Z (. I ," 11�t tY. � �, •.r t�,r. • t U1'i1StC1.'.%Iiv.1I -.+».. I -, l e.or 4,no%1 1 . , J .. . PIR.t.A It . (....----#. • • '/ . • ..�„r 7. SIGNATURE &INFORMATION FOB., ,ruN L4 ram"" ww0.—..,...., ♦ . Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: di y6 am/pm , Depart: am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: NAME: law \ PERMIT NO.: `-)- t LOCATION: AtiM iVE 6 INSPECT ON: — —011 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 0 ft. _ 6112 tie-I) Depth of trenches 34 ft. Size of Stone 2- Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box t1" i VL Distribution Box to Field/Pit 7 ` Opening Sealed(?N/Partial Location/Separations Foundation to tank Fsito . ft. Foundation to absorption 2v ft. Separation of Pits ft. Conforms as per Plot Plan )(Y N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: Approved 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 Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building& Code Enforcement Arrive: P/3 4 am/pm Depart: am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: ,2' NAME: Ceo-1` PERMIT NO.: -c _ LOCATION: 76, gad INSPECT ON: 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. / g L �d �,CJ i Depth of trenches ft. Size of Stone r, Seepage Pits: Number _ h Size: x Stone Size: • Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/Pit Opening Sealed: Y/N/Partial Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y—N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: Approved ,� Partial Approved and needs to be re-inspected,please call the Building&Codes Office / Disapproved L:SueHemingwayU3uilding.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 I I � I W I N i �E�,X�ISTING HELL 1 A£� t73M31A3.4 I '` � JN1�]1I(ls55 1 TIP•) -`= - — END CAP (TYP.) i` ZD CEDAR HEDGE — /-� Z` 3 TO REMAIN p _ 1 '� Ld ? — _ PROPOSED �— — DISTRIBUTION BOX I f PROPOSED =`� _ 55. 0 __-- 1 �,�P• — — ____- CK ISTRIBUTlO BOX _ — —` SHED ___._ -- ____ � ,.• ,� C —1 —2 PROPOSED 50% EXPANSION AREA I �C ----' �� � TRENCH LIMITS (TYP.) PROPOSED ABSORPTION FIELD 1 3 M SEE DETAIL THIS SHEET 1 o N 3 c= 4"0 PVC NON—PERFORATED PIPE W EXISTING TREE 11 SLOPE Y♦" PER FT. (TYP.) TO REMAIN Q 3 4 BEDROOM I I OUSE EXISTING WATER 1 I I WELL TO REMAIN DAVID CERNY O ' _ ST FOR IRRIGATION 297.7-1-1.1 1 I D — (SEE NOTE 1) 766 RIDGE ROAD _ EXISTING 3/4" WATER SERVICE I SEPTIC I , y D EXISTING SEPTIC I TANK TANK TO REMAIN 1 �.! EXISTING DRY WELLS _ Cif FILLED IN PLACE OR i REMOVED PER TOWN 3 I 3 OF QUEENSBURY CODE o ►I� I ST EXISTING 12" D.I.P. 1 WATER MAIN (TOWN OWNED) � 1 I It 11 EXISTING PIPING TO — II i BE ABANDONED (TYP.)It — v o EXISTING SEPTIC g I TANK TO REMAIN — 1 GARAGE WITH o I II RESTROOM FACIUTIES 4"0 PVC NON—PERFORATED PIPE i I I o II (NON—LIVING SPACE) EXISTING = O II I _ - --'`—WELL TO REMAIN f/4" PER FT. SLOPE to 0 i W II I - FOR IRRIGATION 1 v 0 ►i 3 _ (SEE NOTE 1) I o' %Of 0 4 i I' ' _ — — 76 Z 0 _ = RIDGE ROAD SITE PLAN SEPTI SCALE 1-20' ANK x n I 11 20 0 20 40' IZ�4tf cnz_.� ,r d. o GENERAL NOTES: I�i `t {M thti d1i, n Y a . PERCOLATION TEST NOTES: DEEP TEST PIT NOTES: 1. QUEENSBURY WATER DEPARTMENT TO VERIFY THAT 1 Fes;X 0 1)P-1-PERC TEST NO. 1 - 10-INC-4ES WIDE EXISTING WELL WATER SUPPLIES ARE NOT CROSS 30-INCHES DEEP. TEST PIT WAS EXCAVATED TO 8-FEET DEEP. PROF�OSED ABSORPTION FIELD s7��NA --- o CONNECTED TO THE POTABLE WATER SYSTEM. -SANDY LOAM 0-8 FEET DEEP W/ ROCKS - - PROPERTY LINE SCALE 1=10' DATE co (2'-10" DIA.) IN TOP 2 FEET. W — WA LINE 10' 0 10' 20' 10 2.UNDERGROUND UTILITIES SHOWN ARE APPROXIMATE —TIME TO 1—INCH DROP GAS NE i TRIAL 1-4 MINS —GROUNDWATER/MOTTLING AT 6 FEET DEEP. IN LOCATION. CONTRACTOR TO OBTAIN A DIG SAFE r 3 TRIAL 2-4 MINS NEW YORK STAKE OUT PRIOR TO CONSTRUCTION. --------- CUL T of TRIAL 3-6 MINS 6 3.BASE MAPPING PROVIDED BY AZIMUTH SURVEYING, TRIAL 4-7 MINS TREE >o DATED JUNE 2003 AND SUPPLEMENTED BY THE TRIAL 5-7 MINS M TOWN OF QUEENSBURY, DATED OCTOBER 2004. 2)P-2—PERC TEST NO. 2 — 10—INCHES WIDE � BUSHES 1� 4.A NEW WATER SERVICE SHALL BE PROVIDED FROM 30—IN:HES DEEP. THE 12—INCH WATER MAIN TO THE HOUSE. THE m GARAG R SERVICE SHALL BE CONNECTED —TIME TO 1—INCH DROP QOOO STONEWALL Q� TO TRIAL 1-1 MIN 8 SECS ___ I — DITCH THE b'� PLUMBING. THERE SHALL TRIAL 2-1 MIN 40 SECS P-1 W BE ONLY VICE FOR THIS PARCEL. TRIAL 3-2 MINS 17 SECS ADO Al ® PERCOLATION TEST 2 I TRIAL 4-2 MINS 1 SEC TRIAL 5-2 MINS 30 SECS T-1 --� TRIAL 6-2 MINS 13 SECS, DEEPTEST PIT TRIAL 7-2 MINS 19 SECS 7� 2� NJP REVISIONS COMPLETED CONSTRUCTI Sheet Number ON TOWN 01= QUEENSBURY ecN rIncharge of Dote NOVEMBER 2004 - Scale 'tOri CONSOLIDATED 'WATER DISTRICT or•"£ JAB2 Significant Construction �,g,DA.s © G- 1 A Designed by AS SHOWN Changes Are shown O 1C�lCe P C WATER TRANSMISSION SYSTEM IMPROVEMENTS `'fit Drawnby TA" SEPTIC TREATMENT SYSTEM File Nu mber NO ALTERATION PERMITTED HEREON EXCEPT By Date COI1Sll� � � Engineers � � � by AS PROVIDED UNDER SECTION UCA SUBDIVISION T REPLACEMENT AND DETAILS 2 OF THE NEW YORK STATE EDUCATION LAW. rp p00 �� ' Ck'd Date 2 Corporate Plaza 264 Washington Avenue Extension Albany, NY 12203-6352 SSiG �L 686.003—01 F TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK II p T 4