2013-154 TOWN OF QUEENSBURY
111
742 Ba Road ueensb Y 2804-5902 518 7 1- 201 y ,Q ury,N 1 ( ) 6 8
Community Development -Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130154 Date Issued: Monday, April 29, 2013
This is to certifythat work requested to be done as shown byPermit Number
q P20130154
has been completed.
Tax Map Number: 523400-279-017-0001-062-000-0000
Location: 169 SUNNYSIDE Rd
Owner: MICHELLE & RICHARD BILLINGS
Applicant: MICHELLE & RICHARD BILLINGS
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 ,Z)J14
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
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130154 Application Number: A20130154
Tax Map No: 523400-279-017-0001-062-000-0000
Permission is hereby granted to: MICHELLE&RICHARD BILLINGS
For properly located at: 169 SUNNYSIDE 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: MICHELLE&RICHARD BILLINGS Septic Alteration Residential
169 SUNNYSIDE Rd Total Value
QUEENSBURY,NY 12804-0000
•
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
BP 2013-154
Septic Alteration-Residential
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,April 19,2014
(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 R'i ee``.. ury; Friday pril 19,2013
SIGNED BY `q for the Town of Queensbury.
Director of Building&Code nforc ent
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only
TAX MAP NO. /I f/I) -'I-tor ,X PERMIT NO. 1 3 —f 541 PERMIT FEE 4/0
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
OWNER: RtCI4Ak0 E /1..EL(...r.A6S INSTALLER: -,STO A)IE mArelSrol Lift I'Co )
ADDRESS: 1(07Swurt' aDo 2a Cab'I ADDRESS: 1/30S'Aeran-i1 c .SAP ►i nG A SPA.(WO'
PHONE NOS. 3 l4 -acso-a99 a PHONE NOS.,SI8' 5'fa i0 VI
LOCATION OF INSTALLATION: ;Act‹y"3gz0 IIcp 9 S U•u6vy 5,POLY IQO
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = co INSTALLED?
1981 -1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING `"' STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
V BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?�
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: tO ft)
✓ PERCOLATION TEST: RATE IS \ ,7' PER MIINUTE PER INCH[mpi] (Test to be completed by a licensed professional
engineer or architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed professional engineer or
architect(unless installed in a Planing Board approved subdivision).
TANK SIZE: \l OO GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa or whirlpool tub.
SYSTEM TYPE:
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X
0 S • AGE PIT(S)(WITH NO. 3 STONE) How many? Size?
ALTERNATIVE SYSTEM Bed or other type? Lc'11. TC31
P(C36'aT1p Zs 6izyF,
o HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL
INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
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 QUESTIONS? CALL 761.8256 OR EMAIL
p2eirig)isposal Ordinance. codesr7a.aueensburv.net
� ifs/ /i
VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person Responsible Date www.dueensburv.net
,-----, , 1 D
Septic Inspection Report
Office No. (518)761-8256 Date Ins i reqi - l
Queensbury Building&Code Enforcement Arrive: a part: ' am,pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: i _
/-5NAME: ' NO.:
LOCATION: L 9 SPECT ON: oA C ,01-61/J
RECHECK:
,.. '"°`-1
" Comments and/or diagram
Soil Ty,-. Sand:. •arr�'/ ClayIf
Type of Water: r icipal/1yell Wa f
Waterline separati$djstance -ft.
Well separation distance l I~,O ft.
Other wells: _ l D 2ft.
Well Casing Length 50'+/- Y N N/A
[150'to well required if NO)
Absorption Field: Total lenic th (c t __ft. �---
Length of each trench zi 1,V 1 ft. f --'0��`�—� L,DA N
Depth of trenches <2-'0--, ft.
Size of Stone
See Pi ber
L�, ,Nc_\-, c5 r) Size: _, _x
Stone Size: 7-
Piping Size Type
Building to tank y,1 e /=,C\-\ 1--1r
Tank to Distribution Box �` c_ '-. -t ' _
Distribution Box to Field/ Pit _ I- '' 5C42�C- 'Vt.\ \-t " \� �3�_.—
Opening Sealed: N �,� L �
End Cap Y/_NV-1
Inlet/Outlet Pipes&Baffles �/Y ^T N
12" gradeN
Manholes or less below
[provide extension collar if Yes] Y�,..N
Location/Separations
Foundation to tank •\ ft.
Foundation to absorption (BOA _ft.
Separation of P' ft.
Conforms as per PIpt$lan _N 43e'571 \`Lr�
Engineer Report an As-Bull a/Y—N
ETU Maintenanc Con Y N
provided
Location of System on Property:
Front Rea Left Sid Right Side //le Middle Rear
stem Use Status:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report03 29 10.doc
� �r_
Septic Inspection Report
Office No. (518) 761-8256 Date Ins.- ion r-•u-- lv-•
Queensbury Building&Code Enforcement Arrive: .' i► -�•rt: "":17,--10 m
742 Bay Rd., Queensbury, NY 12804 Inspectors Initia s:
NAME: (31 Ci3 PE' IT NO.:
LOCATION: I (s)9 c-1)00 3 0 iDE R ) SPECT ON: 1+ z 13
RECHECK:
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'+/ - 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: . As t LT
Piping Size Type
p 9
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: Y N
End Cap Y N
Inlet/Outlet Pipes&Baffles Y,V N
Manholes 12"or less below grade Y—N
[provide extension collar if Yes] _ Y N
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per PI _ N
Engineer Report a As-Bui Y N
ETU Maintenance Contract _Y r,N
provided
Location of System on Property:
Front R r Left Side Right Side Middle Front Middle Rear
S stem Use Sta s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report 03 29 10.doc
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