SEP-000332-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Nurnber: SEP-000332-2017 Date Issued: Thursday, July 6, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000332-2017
has been completed.
Tax Map Number: 279.18-1-21
Location: 15 SUNNYSIDE RD EAST
Owner: Ryan St. Lawrence
Applicant: Sanitary Sewer Service
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEENSBBUURYA
Issuance of this Certificate of Compliance DOES NOT relieve the r _ // /J
property owner of the responsibility for compliance with Site Plan, ���yyyvvvl"!k!"' VVV
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 12804-5904 (518)761-8201
OL Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000332-2017
Tax Map No: 279.18-1-21
Permission is hereby granted to: Sanitary Sewer Service
For property located at: 15 SUNNYSIDE RD EAST
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
Owner Name: Ryan St.Lawrence Septic Disposal-Residential $0.00
Owner Address: 15 SUNNYSIDE RD EAST Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Sanitary Sewer Service
PO Box 224
Glens Falls,NY 12801
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,June 22,2018
(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 of ns / I '�tursd Ju 17
SIGNED BY: !.�'"� for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT _ Office use Oniv
DBIE - h, Received
__.---___.__...i Tax Map ID
rAxKAP/D __ , s ! 2 •i -� v, Permit No. c
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Address
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Year Built #of bedrooms X Gallons per bedroom =Total Daly Flow
1980 or older 2— z?-C, Garbage grinder Installed _Y N
1981-1991 Spa or Hot Tub installed _Y _
1992-Present
PAS/ LRMrBrATI01y
Topography _Fiat rolling _Steep slope _%slope
Sob Nature _Loam _Clay _Other
Groundwater At what depth?
Bedrock/Impervious Materiel At whet depth? 1-79
Domestic Water Supply _Municipal _Well(if well,water supply from any septic system absorption Is_R)
Percolation Test Rate: /- 3 per minute per inch(test to be completed by licensed engineering/archhect)
I XIS /CJS
Tank Size zn�gallons(minimum eine 1,000 gallons,add 250 gallons to size for each garbage grinder or We or trot tub)
System Type Absorption field with#2 sone Total length L—1t.;Each trench Sy x_
Seepage Pit rrilh#3 alone How many: —;size
Alternative System Bad or other type?
Holding Tank System Total required capaoity? Tank size #of tanks _
Motes: 1)Alarm system&associated electrical work must be inepwW by a Town approved electrical inspection agency;2)We will no longer
allow systema m be Covered until such time as an As-guilt plan Is received&approved. The installed system must match the septic system
layout on Ale-no exception&.
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 terse and all requ ems fthe Town of Queensbury Sanitary Se, Ditsposal Ordinance.
Print Name:
L=142L fJ f Date: ^,— /1 -! 7
Signature: e, =,�f Date:
Town of Ousensbury Building&Codes Septic Dleposei Permit July 2014
279.18-1-21 SEP-000332-2017
St. Lawrence, Ryan
15 Sunnyside East
Residential Septic Alteration
TOWN OF QUEENSBURY
0
BUILDING & CO ES P'f.
Reviewed y: _
Date:
i
BOUILDING DEPARTM NT
Base on our limited examinatio ,compliance Q
with our comments shall not be construed as Irl
Indic ling the plans and sped �alions are In
full C Dmoiance with the Building Codes of
New fork State.
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ko SEPTIC PLOT PLAN
c I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
1 SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY
MEOU EDTHEDIST Ct S F TH ON THIS DIAGRAM.
3 � U1ti lD-- &- l5'- l7
SIGNATURE DATE
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