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2015-277 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development-Building&Codes (518)761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20150277-42081 Date Issued: Tuesday, December 19, 2017 This is to certify that work requested to be done as shown by Permit Number P20150277-42081 has been completed. Tax Map Number: 290.5-1-29 Location: 156 SUNNYSIDE RD N Owner: David Madden Applicant: David Madden This structure may be occupied as a: Residential Septic Alteration 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,NY 12804-5902 (518)761-8201 ir0 Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20150277 Application Number: A20150277 Tax Map No: 523400-290-005-0001-029-000-0000 Permission is hereby granted to: DAVID C MADDEN LIVING TRUST For property located at: 156 SUNNYSIDE RD. NORTH 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 C MADDEN LIVING TRUST Septic Alteration Residential 3799 STATE ROUTE 9L Total Value LAKE GEORGE NY 12845-0000 Contractor or Builder's Name /Address Electrical Inspection Agency SANITARY SEWER GEORGE DRELLOS 792-7257 PO BOX 224 GLENS FALLS NY Plans&Specifications BP 2015-277 Residential Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,June 30,2016 (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 a ate. Dated at the own o uee „esday,June 30, 2015 t SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement , , 1 SEPTIC DISPOSAL PERMIT 1 ----"" Office Use Only , 1 DATE Received _ i TAX MAP ID i ')Cr 05-1-2? Tax Map ID * -9 0, 0 5-1,9? Permit No. '' . J.,:i 2 6 . a-v 6-'<7/------" V PermitFee 1 (72-(0 _JP LOCATION OF INSTALLATION / :5-- ,)' ,96" A -p--/ -ke- eApprovals: )ING & CODES APPUCANT Prn-e /11/1-1;6,- PHONE/E-MAIL ADDRESS /5 6- fe-t,../, fide 001/Vi-V INSTALLER/BUILDER: ,--S-4-1\-'1 -7,A---k, ife--tA /z__ Lle,e--/ce PHONE/E-MA1L 771 :17- - ADDRESS: I- 69 gp_, 22 7e0A-5 /4-4/. /1 / c7 OWNER otitc._ /2- I4Iie ---- PHONE/E-MAIL Address /_S----6 Sut-fLt .c i --/C A- 1 & _ CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: 6:eb(}-e._ 6,..a. .?, PHONE . -/6-- --372( RESIDENCE INFORMATION Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow 1980 or older Garbage grinder installed Y 4 N 1981-1991 Spa or Hot Tub installed _Y .‹N - . 1992-Present 2— /70 2 2 0 , PARCEL INFORMA77ON Topography Flat rolling X Steep slope %slope Soil Nature Sand L._.- <" Loam Clay Other Groundwater At what depth? Bedrock/Impervious Material At what depth? Domestic Water Supply Municipal Well(if well,water supply from any septic system absorption is ft.) Percolation Test Rate: per minute per inch(test to be completed by licensed engineering/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION Tank Size ./67 gallons(minimum size 1,000 gallons, add 250 gallons to size for each garbage grinder or spa or hot tub) System Type Absorption field with#2 stone Total length ft;Each trench x _ Seepage Pit with#3 stone How many: ;size AAlternative System Bed or other type? Holding Tank System Total required capacity? Tank size #of tanks Notes 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency:2)We will no longer allow systems to be covered until such time as an As-Built plan is received & approved. The installed system must match the septic system layout on file–no exceptions. DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or failure to make a material fact or circumstance know by or on behalf of an applicant, shall be void. I have read the regulations and agree to abide by-these and rewiothents of the Town of Queensbury Sanitary Sewage Disposal Ordinance. Print Name: (,---te2e9 • ,,.. cf...,„-/ — Date: c -- Signature: —oar 4,' e .----- --- -------er Date: ( - 2( - A-) Town of Queensbury Building&Codes Septic Disposal Permit July 2014 Town of Queensbury Building & Code Enforcement Office No. (518)761-8256 Septic Inspection Report Inspection request received: "„( Name: " ��� Inspected on: /Pr Location: /5L 1V Arrive: I p.m. Permit No.: l C-7-11 Inspector's Initials: 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. Well Casing Length 50'+I- Y N N/A [150'to well required if NO] Absorption Field: Total length ft, Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box .R4C( Distribution Box to Field/Pit Opening Sealed: Y N End Cap Y N Inlet/Outlet Pipes&Baffles Y N Manholes 12"or less below grade _Y N j� r [provide extension collar if Yes] Y N Lir --N-44"-- Location ' 4 . —Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Engineer Report and 's-Built Y N ETU Maintenance Co . provided 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 (✓ Septic Inspection Report G. Peter Jensen 17 West Road ,, p E.3 South Glens Falls rD P; L.. r New York 12803° (518) 798–3859 _ JUL 2 3 2015 I July 09, 2015 TOWN OF QUE fNSBUIZY BUILDING& COOPS To Whom It May Concern: �–'— I have designed (plan 14-0510)and observed the installation of the septic system for Dave Madden at 156 Sunnyside Road North, Town of Queensbury, Warren County, New York. It would appear that the installation is within the intent of the design documents. To the best of my knowledge and belief, no field conditions were encountered that would require a re-design of the septic system. To the best of my knowledge and belief all of the distance separation requirements have been met. Sincerely, G. P;!' Jensen sp,E0 qq ER cti QCY Fy . tf "� * 1 \ to. °cam ito t0 w# + Nf` ©`�✓ Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: am/pm Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials• –`'') NAME: PERMIT NO.: 2 INSPECT ON: R RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/ Clay Type of Water: Municipal/ Well Water Waterline separation distanceft. Well separation distance _ _�_ft. • her wells ft. Well Casing Le'gth 50' + / - Y N N/A [150'tow: I requi -d if NO] Absorption field: To •1 length ft. L: gth of eac trenc ft. Depth oft ench:s Size o St• e --page Pits: •-r ize: Stow. Size: Pi• ng Size Type f ae.-f)cC`i Building to ank Tank ,o Distributi• Box Distributio Box to Fi: d/ Pit T �,^ r',c Openin• Sealed: Y N End Cap YN Inlet/0 , let Pi•: &Baffles Y N Manholes 12" 1,r less •-low grade Y N [provide ext;nsio collar if Yes] Y— N L• ;ti. / Separations ndation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot PlanT N Engineer Report and As-Built _ N ETU Maintenance Contract Y .__ N provided Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: • •ved P:rtial Approv:,• .nd needs to be re-inspected, please call the Building &Codes Office L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report_03 29 10.doc Town of Queensbury Building & Code Enforcement X1,1,(, Office No. (518) 761-8256 t 3 Septic Inspection Report Inspection request received: 'kAk 1A Name: tl Xl Inspected on: 2A_5 Location: 1, Sn+-vyS 1 c �n Ik t- Arrive: _ - b a.m./p.m. Permit No.: V) 211- U Inspector's Initials: _1.4.111 Comments and or diagram Soil Type: Sand/Loam/Clams Type of Water: Municip /Well Wat Waterline separation dist r0-L "ft. Well separation distance ft. Other wells: ft. Well Casing Length 50'+/- Y N N/A [150'to well required if NO] Absorption Field: Total length ft. `�' Length of each trench ft. c�� Depth of trenches ft. Size of Stone f-Z..— Seepage Pits: Number Size: x�..- Stone Size: I 11 Piping Size Type Building to tank A Tank to Distribution Box MtIC° Distribution Box to Field I Pit v.v D Opening Sealed: _Y_N End Cap / N Inlet/Outlet Pipes&Baffles VS'' N fR, ✓ Manholes 12"or less below grade ✓Y/ N [provide extension collar if Yes] VY N �j �� � Location/Separations Foundation to tank 0_ft. 1 Foundation to absorption 0 ft. Separation of Pits 1-ilipkt: Conforms as per Plot Plan Y t Engineer Report and As-Built Y N ETU Maintenance Contract provided _Y Location of System on Property: Front R ar Left Side Right Side Middle Front Middle Rear S stem Use Stat s: Ate oyes 'artial Approve. .nd needs to be re-inspected, please call the Building&Codes Office I ... .'-S 4 Septic Inspection Report L N F � i �` w A85OR#Frc7nr BED .SECTT"/Ot-, �. bbl C c I cy /. 2 F3 D({CiOtv1 F�r�;aiC)icl\yC X20 GGTO FLOW RA,-rL - IN SOIL TEaT PIT REYEAL.CE)i .. .. WrTM A t v1lt,ifi 6" 55 SECOND PEFRaOLAT/ON RA"E 'R&4t)IRES a-7" Tap-sotL � Z32 S,F f3CO APGA- P-454Sr pR0V1OEDC7'Xa5r). 7'1..5eUtvOwty My -014) ! FINE SAND - 2, LATER^L-S I y ,� WITH i�6 HC)i-ES ?.'SPACED 30"O -C, Sd'-b r, YELLOW bpowN MEDjuhi ZAND 3. LA,CRAL LEr.tG-rH aQ'. P [ Rt fl! -!A, S`1Gt. ;i" E,-" f' A, 12 HOLES PER LA-rCRAL & 1,04 GPM CQUALS 12,48enPM, t 5 r✓ll JIt.AtiM DOSE VOLUME G/OGAL-CLSIGN V0L1:ME-55GAL-,~l PTS (or /.�1�y HARGtF RATL )2..�48GPM, 1 N(!N /(y-5t-,hR.. �..!Y�P N_ 14 -54z; 7. C�R+IT+ON LliWw IL1 2"L?kLIVERY P(F8 6.82 TCST�z I Rrl!!3 it maBC )wmi" 30*,Ee I LIFT 22 0 -re67*S l M/N 8�9 I IN405E� '9 -j F A TOTAL PUMPIaVCa tNEAO ZS. i Z! U ,i /-Miui1 SSSECGNta; Fort oe:afos .I P(:M" CAPA5l r, OF 0ELfVE'R11,,5, 1,'F. ,&'P,? AGAtNS t a OF j htzl�+J tRE�U`RE'6�, W�i.L . I g, 5E -r LATERAL DEAD LE VEL WITH HOLES DOWN, I t C�, PRoVfDE W.ECPs, IN 1.IF`t' a?':i T+Otai 'TU FACl1-+TNT4 DRAINING OF � I DELIVERY PIPE VVHZLN PUMP 13 OFF' 1p, HIGH A,^,rEp I,-,omoi'r,pN fN Li 12T S7A"r CC? N SHALE.. AL?"iVATF. AN _ AU018LE ALARP4 �/iT;+i n: FSS it Li leN Et I 1 �. NU YOR-'.'1 CaN OF SE Pi'fG SYSTEM 3NALL T3E W/Tl�114 /O' C. --F ANY , r i PROPER'T'Y LINE, /2, hi0 OF Ar-!,sUF P7' 4>N ARI=A SHALL 315- Wrrk,•v rrJ 6 OFC AIJY WELL) LAKE, ;;>7;4i AMr POND, RIVcR eDR VdZ5TL- ANP, /3,1NSTALLATtOr1 AAUST Se +NSPECT{!'-pP 0i' -TO CovER,n $Y TME , �= ExfSTrNr. TRe } $Vt!_D11V(, /N3?'EG-TF€ OF THC �C{) T-nWN OF--- ' 3' 6 _t- -- TDP 501 L y' .SEED r --NATIVE +aA�P"KFILL /r— Gr,0 i EXTiif-E FABR k:. 1,A7P1,RAL _ _. ,,-EXi57'ING �RAD� i G L G N F � i �` w A85OR#Frc7nr BED .SECTT"/Ot-, �. MANHOLr COvER --- IN,, kNL-K.,. `'j►...+ 2."A8O':(r` OUTLET CAULKEO 161t,17- c I cy N T$ .. .. - f � - I gHDRE L N AML 1 "u } I '9 -j F A III .I I � . EXI_}TtNG W�i.L . i i I �JC1�' 7,r«c1 � I I ---4',o OLID 'PIPE .. # 7GN .4 P& F L ''T i $ , �= ExfSTrNr. TRe } I j R6:51D6r1,... _t- tr-1DDOC,+0.LCMIN)SEFT'' ntz 4"0 SOL10 P/ r� w1 PES? F-UGY 'Tl —S✓°D &At- L1 FT S'r,GYiAN� DEL_IVER-t- pipe R`XL` /ry TREE I : I j � s p 6 EXI.`�:T4H,a FP?LG--_ fi UTILITY 3a� � EN i cRv I — NCIGN6DRtN� VVCLL MANHOLr COvER --- IN,, kNL-K.,. `'j►...+ 2."A8O':(r` OUTLET CAULKEO 161t,17- c I cy �,A ti!rARY TAY - f � � "u } '9 -j .I I FILE COPY INFLUENT TOWtc 1-T G BUIL AG & Rev; - Vet3 By Date: _-- /i U JUN 2 6 2015 1II� L.l 0 mi SEF! }C TANK SEGTt0N NTS CERA CE IVAANHOLE_ COYER OUTLET CAULKED JOIN y -EFFLUENT FILTER ._.._ SEPTiG TANK cRU5HEI7 rj7Z+rlE(4-� -RELAY i t\; j Etak:l-G�UPP-- r- VEtVT 1� _..LO�KA�LE COVET" -- MAH HO L.E ClJVER / f r HANGER FOR RN -4P Cy to ii•} C1 EFFLUENT O PC v i NIG WA7FR ALARM LEVEL ! { I SW1Tcu SW IRT TLE VEL SHUTi3>Fr LEVEL 5W1TGh1 Min CRUSHED S7Z)NE(4'-iD 1_l1= T STA.`)` 1' Kf SE4 71014 IV TS PERMIT PLOT PLAN I HAVE PERSONALLY MEASURED THE DISTANCE FROM THE PROPERTY LINES TO THE PR OSED STR CTU 7(S) OR SIGN(S) Haan 1 1 DATE Dave Madden BP 2015-277 �O NE14-.480pir%1; wC—;) 156 Sunnyside Road North 7L0-7 P L ,~7. r Septic Alt. - Residential it is a Violation of the Law for any Person, I Unless Acting Under the Direction of a i Licensed Architect, to Alter nny Portion of This Document in any way. it any Porion of this Document is so Alle,ed. the ANering Architect Shall Affix to the Portion so Altered his Seal and the Notation "Altered By" Followed by his Signature and the Date of Suct'. Alteration, and a Specific Descriptioin 1%f the Alteration. DAVE MADEDE N G. PETER JENSEN Pt_Ati1 17 WEST ROAD SOUTH GLENS FALLS NEW YORK 12803 M4Y 1-:�r A, wlU COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC. Main Office 176 Doe Run Road-Manheim,PA 17545 MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL Permit No.P.I.V.......... .............. Cut-in Card No..................................... N`1502-�4.. ......Cert. 44877 Owner..........�>... ...4 ..Kdr......... . . ............................ ;7Y.............. Location..........4!5... .. f.. ).........................4. .................... Installation Consisting of...;Ce_ .... ............................ 4 ................................................ ..It c'p........................................................................................ .................................................................................................................................................................................... Installed By.... ......r�..CV ...Lic.No................................................... The conditions following governed the issuance of this certificate,and any certificate previously issued is cancelled:- This certificate only covers the electrical equipment and installation conditions as of date. Upon the introduction of additional equipment or alterations,application shall be promptly made for inspection. Inspectors of this Company shall have the privilege of making in ns at any time, and if its o t rules are violated,the Company shall have the right to r v V is cc ica ............ INSPECTOR..................f...................................................................... Member N.RP.A.,I.A.E.I.