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2004-158 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development- Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit.Number: P20040158 Date Issued: Tuesday, April 13, 2004 This is to certify that work-requested to-be done as shown by Permit Number P20040158 has been completed. Tax Map Number: 523400-290-005-0001-051-000-0000 Location: 160 SUNNYSIDE Rd Owner: TYRONE & TAMARA BAPP Applicant: TYRONE & TAMARA BAPP This structure may be occupied as a: By Order of Town Board Septic Alteration Residential 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: P20040158 Application Number: A20040158 Tax Map No: 523400-290-005-0001-051-000-0000 Permission is hereby granted to: TYRONE& TAMARA RAPP For property located at: 160 SUNNYSIDE Rd m 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: TYRONE& TAMARA BAPP 160 SUNNYSIDE Rd Septic Alteration Residential Total Value QUEENSBURY, NY 12804 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2004-158 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,April 08, 2005 (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 Town7:7 Th r d ,April 08, 2004 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit--Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: ............ Office Use Location of installation: S U!�/V SA I'd ��Gt- J File Permit No. Tax Map No. 2(� Fee Paid Owner's Name: Address: 0 ......................................................... ................................,,,........,..,...................... 2. INSTALLER'S NAME : (N�1'/7 e�/e t/CA'S PA/ _ PHONE NO. 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply#of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: ( � No. of Bedrooms x Computation = Total Daily Flow �— APR (' ) 2004 1980 �91 x 150 gal/bdrm = LJy TOWN OF Q[j-LENS BM - x 130 gal/bdrm BU! NSBUR LDIP+lG ANU COD 1991—present x , 110 gandrm = E Garbage Grinder Installed yes_ / no Spa or Hot Tub Installed yes^ J no 1/ 4: PARCEL INFORMATION: (circle applicable information&indicate measurements) PRg4aphy Soil Nature Ground Water Bedrock or impervious Material Domestic Water Su 1 l sand at wh t depth at w at depth municipal Rolling loam N Meet feet well Steep slope clay if well; water supply slope other from any septic-system depth: absorption is J,00 ft. other Percolation Test: (To be completed by licensed professional engineer or architect) Rate: , D _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: gallon (min. size 1,000 gal) Tile Field: each trench-r}=ft. Total System Length: 2VV__ft. Seepage Pit(s): number of size of each: ft. by ft. Size of Stone to be used: # _ / depth or thickness_ Z _feet / Bed System Size: ©D x Alternative System: length and/or 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 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 Sanitary Sewage Disposal Ordinance. d Signature of responsible person Dat • •,I t}�Vtt �}� �,�tJl;�?}ICI}tlt•y . App-omlix C, - A-1.1-80Rx'•'V];ON ININA) SP:P11 RN1'10 N RIVAIl.Ji i ENI MIN Y'S ' 6,1 PON a 1�1'Lt.1_ ul t�hTR it,• rt u'14.1 Wit 164 00, G . 1'�aY, �.'. �' ' 1 l .� ,�' '' t�.t rr. •I ` ����•� f 1 Mtn talSttl:11i1�♦t t w . A�y�t}RPtK11 E`tK > [tom) 7. SIGNATURE &INFORMATION FWL USFUNS1014 rzg%zvj,•1\,.v,a--•'0--:; - ,YZ) Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: J 3 4-6-ej Queensbury Building&Code Enforcement Arrive: am/p epart: a prn 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: ' C NAME: �f PERMIT NO.: y/ LOCATION: /6:219 INSPECT ON: %3 RECHECK: Comments and/or diagram Soil TypkSand/L /Cl Type of Water: Municip /Well' titer Waterline separation distance ft. Well separation distance ft. Other wells: LLD ft. -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 5 Tank to Distribution Box Distribution Box to Field/Pit N ti Opening Sealed: Y/N/Partial Location/Separations Foundation to tank Ile, ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Location of Sys on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Statt Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved LASueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 "I have:seen or observed, or believe I saw evidence of, all objects such as houses, wells, trees, fences, etc., if LL shown on this document. I also represent that I have personally measured the dis ances set forth on the diagram." f-D Q t C) -41 SIGhIATURE DATE. 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