2001-169 E '` TOWN OF QUEENSBURY
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742 B Road ueensbu NY 12804-5902 518 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010169 Date Issued: Friday, September 21, 2001
This is to certify that work requested to be done as shown by Permit Number P20010169
has been completed.
Tax Map Number: 523400-239-019-0001-001-000-0000
Location: 18 CEDAR POINT Rd
Owner: JOHN & DIANE MATTHEWS
Applicant: JOHN & DIANE MATTHEWS
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
` ow 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010169 Application Number: A20010169
Tax Map No: 523400-002-000-0001-009-000-0000
Permission is hereby granted to: JOHN& DIANE MATTHEWS
For property located at: 18 CEDAR POINT 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: JOHN& DIANE MATTHEWS
C/O RODERICK SMITH Septic Alteration Residential
3219 STATE RTE 9L Total Value
LAKE GEORGE,NY 12845
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans & Specifications
2001-169
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Thursday,April 17,2003
(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 Tow ;i.. • -ensb ; Tues. •y, • pril 17,2001
SIGNED BY i for the Town of Queensbury.
Director of Building& ode E\ orcement
' Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Arial .
Location of installation: I (e i r "KC C. t
' File Permit N
.s
Tax Map No. �_/ /
• Fee Paid ...5"; Ob
Owner's Name: To 1,40 F. etAkn—n6,,)
Address: v,G' � --7 3 a f q Li k \ 1--
kedbe.6(
�C2. INSTALLER'S NAME : 71,4,t_1 7 . 1 rt i‘v�t5 X.611 PHONE NO. 1, ,g ..i3�
3. RESIDENCE INFORMATION: (circle year of dwellin , indicate#bedroom(s)and multiply# of
bedrooms with applicpble gallons per bedroom to equal total daily flow)
MOD t -(eC4T?o-,-) 04 57-
Year of House: No, of Bedrooms x Computation = Total Daily Flow
1980 or older x 150 gal/bdnn =
1980— 1991 x 130 gal/bdrm =
1991 —present ' — x 110 gal/bdrm = ,
Garbage Grinder Installed yes / no (7' 1.v
Spa or Whirlpool Installed yes / no
2001
APR '1
:e . _it�fe,oRY
4. PARCEL INFORMATION: (circle applicable information &indicate measurements}i0y►.>t� .00E
man oil Nature Gl un&Water _Bedrock.or Imperyiqus Material__Domestic Water_Supply
Nat sand at what depth at what depth municipal
Rolling own - feet i v feet well
Steep slope c ay if well; water supply
o %slope other from any septic-system
depth: absorption is ice ft.
other L/f{4
Percolation Test: (To be completed by licensed pro fessional 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 In the size
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. • -�—
Septic Tank: 1pr,O gallon (min. size 1,000 gal.) /1 / V
81 i v.:‘ Ati o t 5
Tile Field: each trench ft. Total System Length: fl.
Seepage Pit(s): number of size of each: ft. by Jt.
Size of Stone to be used: II / depth or thickness __Pet
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 Town of Queensbury Sanitary Sewage Disposal Ordinance.
0A11C)11,,A 441 4j___ #
e
1 n ture df responsible person Da
f'� BP
John P. Matthews
3219 Rte. 9Lr,: ` 6
=` ��J
Lake George,NY 12845
co
NOV 21 1997
November 21, 1997 TO I.','; __ _ :SAY
B�!L ;NG m(,,L CODE
John Goralski
Planning.Department
Town of Queensbury
Queensbury,NY 12804
Dear John:
As per your request, this letter is to reaffirm that the use of the storage building proposed on my
property at Cedar Point will be used for personal/seasonal storage and a personal workshop area.
Pro p
It will not be used for commercial use.
Sincier v, ___,
,U /`
John P. attl1
i
A,Se M b I y
Speaker Heck .j
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