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2000-840 TOWN OF QVEENSBURY 742 Bap Road, Queensbury, NY 12804-5902 (518) 761-8201 Community Development as Building & Codes (518) 761=8256 CERTIFICATE CIF COMPLIANCE Permit Number: P2O000840 Date Issued: Monday, November 06, 2000 This is to certify that work requested to be done as shown by Permit Number P20000840 has been completed. ��� 4 � I � Tax Map Number; 523400-054-000-0002-010-000-0000 Location. 117 CHESTNUT RIDGE Rd Owner. RICHARD & CYNTHIA SMITH Applicants RICHARD & CYNTHIA SMITH This structure may be occupied as a: By Ordet of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Director of Building& Code Enforcement TOWN OF QUEENSBUR.Y 742 Bay Road, Queensbury, NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20000840 Application Number: A20000840 Tax Map No: 523400-054-000-0002-010-000-0000 L, Permission is hereby granted to: RICHARD & CYNTHIA SMITH For property located at: 117 _ CHESTNUT 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: RICHARD & CYNTHIA SMITH Septic Alteration Residential 117 CHESTNUT RIDGE Rd 'Total value QUEENSBURY, NY 12804 Contractor or Builder's Name / Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY L Plans & Specifications 2000-840 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday, November 06, 2002 (Ifa 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 eensb Man , vvember 06, 2000 SIGNED BY for the Town of Queensbury- Director of Building arc C de E n4orcement k Application for Permit -- Septic Disposal System Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-82.5+6 1 . OWNER INFORMATION: ......................................................................._....... ..................... _.._..........., © Location of installation: �l k t ffice Use l') (a C File permit No( Tax Map No. f' F _ s Owner's Name: f 1 C� yi} i 1 �.' !' + 7 ? l " .. Address: 4:1 rr�rr 0 1 2000 2_ INSTALLER'S NAME r /2 u Ivcr�W N OF r AND CWE NO. .J9`._�/ S 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate # bedroom(s) and multiply ff of bedrooms with applicable gallons per bedroom to equal total daily flaw) Year of House: No of Bedrooms x Computation — Total Daily. Flow 1980 or older .j x 150 gal/bdrm 1980 — 1991 x 130 ,gal/bdrm 1991 — present x 110 gal/bdrm = Garbage Grinder Installed yes . f no Spa or Whirlpool Installed yes f no _ 4. PARCEL INFORMATION: (circle applicable information & indicate measurements) Topogjaphy Soil—Nature Ground Water Bedrock or InWervigus Material .Domestic Water Su 1 Flat and at what depth at what depth municipal allin oam feet ____feet well Steep slope clay r well; water supply �3o slope other from any septic-system depth: absorption is Zz 7 ft. ether 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 Tank; . d 0. gallon (min. size 1, 000 gal.)Tile Field: each trench ft Total System Length: d + 0f (Irl G' Seepage Pit(s): number of size ofeach: ft. by ft- Size of Stone to be used: # / depth or thickness feet Bed System Size: _ , " } x Alternative System: /ti' _ length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons f 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 requirementaj4,the Town of Queensbury Sanitary Sewage Disposal Ordinance_ Sign tore of resp risible pe'rsoW Date TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury kY I2804 (518) 761-9256 SEPTIC DISPOSAL SY M INSPECTION Name Location Date Permi tr 1..�` SOIL TYPE Sand oam-C1 a r Results of Per co tion T ( if applicable ) to-MinTYPE OF SYSTEM:ABSORPTION FIELD: Total - Length of each tre ch Depth of trenches 17 Size of stone SEEPAGE PITS : Numbe ~- Size - ft . x ft . Stone size PIPING: N Size Type Bldg . to Tank i _ +4. Luz, Tank to Dist . Box Dist , Box to Field/ + l p � Openings Sealed ? es art a LOCATION/SEPARATI 0 -- Foundation to Tan feet Foundation to Ab rption feet S Conforms as per Plot Plan a No LOCATION OF SY ON PROPERT ( circle one ) Front Middle Front - Middle� Right Sid Rear COMMENTS : SYSTEM USE APPROVED : /vfs�) NO Arriv Dep d u" di4al Inspector l/ TOWN of QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road 1 ►�`� Queen_ sbury _NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name 14DAt:�) C7[ EL� S ,_J Location Date Permit # , SOIL TYPE : Sand- Loam-Clay Results of Percol ati Test ( if applicable ) Ra - nute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: ota Length Length of each tr nch Depth of trenches Size of stone SEEPAGE PITS : N b r- Size - ft x ft . Stone size PIPING : Size Type Bldg . to Tank Tank to Dist . Box Dist . Box t�Q Field Pit Openings Sealed ? Yes No Partial LOCATION/SEPARATI S : Foundation to Tank feet Foundation to Absorsti on feet Separation of Pits feet Conforms as per Plot Plan '"Res Na LOCATION OF SYSTEM ON PROPERTY : ( circle one ) Front - Rear - Left Side - Right Side Middle Front - Middle Rear ' COMMENTS : - do SYSTEM USE APPROVED: YES No Arrived : 9 yj Departed : Building Inspector "I have seen or observed, or believe I saw evidence of, all objects such as houses, wells, trees, fences, etc., shown on this document, I also represent that I have nally measured t istances forth on the diagram." LJJ j jJJ SIGNATUREDA E 0 c 0 rF1 E COPY �S y ' j J nl� nQ� {7� TOWN Ur QUEEN BURY i BUILDING & EPT. Rv�EvuEri eY [SATE � r