2002-510 f � TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804.5902 (518)761-8201
Community Development-Building&Codes (518)761.8256
uwIFICATE V'r E
PennitNumber P20020510 Date Issued: Monday,December 11, 2006
This is to certify that work requested to be done as shown by Permit Number P20020510
has been completed.
Tax Map Number, 523400-302-017-0002-021-000-0000
Location; 45 OAK TREE Cir
Owner, KEVIN&ROSE RICHARDS
Applicant: KEVIN&ROSE RICHARDS
This structure may be occupied as a;
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance,or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals,
TOWN OF QUEENSBURY
`} 742 Bay Road,Queensbury,NX 12804-5902 (59$)7G1-8201 FILE Qpy
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020510 Application Number: A20020510
Tax Map No: 523400-302-017-0002-021-000-0000
Permission is hereby granted to: KEVIN &ROSE RICHARDS
For property located at: 45 OAK TREE Cir
4
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: KEVIN&ROSE RICHARDS
45 OAK TREE Cir Septic Alteration Residential
Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection.Agency
IBS SEPTIC
IVAN BFTJ.
2 LOWER WARREN STREET
OIIFFNSBITRY.NEW YORK
Plans&Specifications
BP 2002-510
Septic Alteration as per plot plan and specifications
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,June 20,2003
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbu4,f�;e exp' lion ate.)Dated at the Town o Q T June 20,2002
SIGNED BY ------for the Town of Queensbury.
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: P20020510 Application Number: A20020510
Tax Map No: 523400-302-017-0002-021-000-0000
Permission is hereby granted to: KEVIN&ROSE RICHARDS
For property located at: 45 OAK TREE Cir
In the Town of Queensbury,to construct or place
at the above location in accordance with application togetherwith 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: KEVIN&ROSE RICHARDS
45 OAK TREE Cir ..Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804
z�
Contractor or Builder's Name Address Electrical Inspection Agency
IBS SEPTIC
IVAN BELL
2 LOWER WARREN STREET
01 TEENSBI TRY. NEW YORK
Plans&Specifications
BP 2002-5 10
Septic Alteration as per plot plan and specifications
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, June 20, 2003
(If a longer period is required,an application for an extension must be 'Made to the code Enforcement Officer
of the Town of QU bury before the expiration date.)
before
r
our
Dated at the Zwn o )juee
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System
Town of Queelubl"y 742 Bay Road Queembiwy,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
....................................... ................... ...................................
Location of installation: c- (Z- �,-Cc- -r-6c office Use
0
'Fax Map No. jj File Poll
Owner's,Natne: eK Fee Pa ----
Address:
2. INSTALLER'S NAME PHONE NO
A) auftipjjVoy
3. RESIDENCE INFORMATION: (circle year of dwelling, indictile if bedroont(
bedrooms with applicable gallons per bedroom to equal IVg,�e �Qbliz)?,jsau
R
Ai\IE)C D y
Year of House: No. of Bedrooms x Computation = Total Daily Flo
1980 or older x 150 gal/bduin =
1980- 1991 X 130 gal/bdrin =
199*1 —present X 1,10 gal/bdrin =
Garbage Grinder Installed. yes no
Spa or WIiirlpool Installed yes_ no
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
a )IV aturQ 13ed;:qqk r 1p)perviotts Materia J> _
Merl crnr t I'IYet, lepth al vi
7&et ect
Sleep slope clay if well; water supply
%slope other -0111 any septic-sjIsteln
depth: absoiplion is_J1.
other
Percolation Test: (To be 6onipleled by licensed professional engineer or architect)
Rate: —Ininute Per inch
5. PROPOSED SYSTEM: For New Coils(ruction: All individual sewage disposal systetus must be designed by a licensed
professional ciigiucer or architect(unless installed itia Plaiiiihig Board approved subdivision). Add 250 gallons to the size
or oic septic tank and leach field For etch Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: gallon(m1n. size 1,000 gal.)
Tile Field: each french Total System Lciigth:C-->640
Seepage Pit(s): number of size ofeacli: _fl. by
Size of Stone to be used: /1 depth or thickness
Bed System Size: X
Alternative System: length andlor 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 ptirstiant to Section 136-29 of the Code of theTowil
of Queetisbury, any permit or approval granted which is based upon or is granted irt
reliance upon any material misrepresentation or uaiture to make a material Tact or
circumstatice known by or on behalf of an applicant, shall be void.
I have road tlzo regulations with respect to this atalzlication and agree to abide by tlleso and atl
requireiiiatitsc)f the Town ofQtzectisbtir Sanity.1111 'ICY Sewage Disposal Ordinance.
Si-Cwu-re of responsible person Date
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: am/pm
Queensbury Building&Code Enforcement Arrive: amp
Depart:
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials.
NAME: F i C PERMIT NO.:
LOCATION: L41s— UaK INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam lay
Type of Water: Municipal/ Well Water
Waterline separation distance •
Well separation distance ft.
Other wells., ft.
Absorption Field: Total length
Length of each trench
Depth of trenches ft.
Size of Stone
See a e Pits: Number
Size:
Stone Size:
Piping size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field
Opening Sealed: Y/ NJ Partial
End Cap
Inlet/Outlet Pipes SL Baffles F_N
Location Sepprations_,_
Foundation to tank
Foundation to absorption ft.
Separation of Pits
Conforms as per Plot Plan Y N
Engineer Report and As-Built N_j
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
%tggm Use., tus.
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
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