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2000-637 TOWN OF OUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE .Permit Number: P20-000637 Date Issued:. Monday, October.23, 2000 This.is to certify that work requested to be done as shown by Permit Number P20000637 has been completed. Tax Map Number: 523400-050-000-0001-084-000-0000 Location: . 124 SUNNYSIDE RD. NORTH Owner: ROBERT RICCIO .Applicant ROBERT RICCIO 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: P20000637 Application Number: A20000637 Tax Map No: 523400-050-000-0001-084-000-0000 Permission is hereby granted to: ROBERT RICCIO Owner of property located at: 124 SUNNYSIDE RID.NORTH in the Town of Queensbury, to construct or place a Septic Alteration Residential 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. Owner Address: ROBERT RICCIO 124 SUNNYSIDE RD. N. QUEENSBURY,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency QUEENSBURY SEWER JAY SWEET Type of Construction: Septic Alteration Residential Value : $ Plans & Specifications 2000-637 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFCATIONS $25.00- PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,August 24,2002 (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 nsbur Thursday,August 24, 2000 SIGNED BY for the Town of Queensbury. Director of Building&.0 de E rcement Application for Permit—Septic Disposal System � f=- Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: Office Use Location of installation: C f( R (t S c J4-5 I File Permit No 7 Tax Map No. / / 6O Owner's Name: L� d— t C� �' Fee Paid ................................................................................_..................._....................... Address: Y c c `( S c1 -e, 2. INSTALLER'S NAME PHONE NO. 7 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 or older x 150 gal/bdnn = 1980- 1991 x 130 gal/bdrm = 1991 -present x l 10 gal/bdrm = Garbage Grinder Installed yes— E I V LD Spa or Whirlpool Installed yes / n AUG 2 3 2000 4. PARCEL INFORMATION: (circle applicable information&indicate measurements)TOWjq:OI=O'_°_EE,', UjRy El_I�ILDNNG rf ND C�6 rT9posz60it Nature Ground Water_ Bedrock or Imp us Material Domestic Water Supply I _- Y sand` at what depth at what depth nuulicipal Rolling loam feet feet well Steep slope clay if well; water.supply slope other from any septic-system depth: absorp�ti`o,tpi_s/ ft. other 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: gallon (min. size.l,000 gal:) Tile Field; each trench ft. Total System Length: fl. Seepage Pit(s): number of size of each: fl. by ft. Size of Stone to be used:_ li / depth or thickness ----feat Bed System Size: x Altemative System: �d c 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. Sfgnatu e of responsible person Date /C6 12q Sung) {5l �1, 0 O � r P PlfCC T 4Nk:S i ¢ .ve - -- we � _ LI Off— 637 R CC AUG 2 3 2000 Q E7l�` a�gr,dC :1 r N OF QUEENS RY UI UING & T�, REVIEWED BY ATE : Q0 "I' have seen or observed, oT believe I saw evidence-of, all objects such as houses, wells,trees,fences,etc., shown on this document, I also represent that I have personally measured the distances set forth on the diagram:' z SIGNATURE DATE TOWN OF QUEENSBURY BUILDING____& CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name RIC1� Location 17y Date ermi t SOIL TYPE: Sand-Loam-Clay- Results of Percolation Test- 1 (if applicable) Rate-Minute/Inc O TYPE OF SYSTEM: ABSORPTION FIELD: 'Total Length Length of each trench Depth of trenches i Size of stone i SEEPAGE PITS: Number- Size - ft. x. ft. Stone size PIPING: Size Type Bldg. to Tank Tank to Di-st. _Box Dist. Box to Field/Pit Openings Sealed? Yes No Partial LOCATIOWSEPARATIONS: Foundation to Tank —feet Foundation to Absorption feet . . Separation of Pits feet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PROPERTY: (circle one) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS: C)6 1 ��-) T-:tt1L - SYSTEM.USE APPROVED: NO Arrived: �7=� Depar 13 ui Iding I s actor CUMMUIN W EALl H ELEU l M-AL llvJYr,l,l lvly 3r nv l%.r.,iivi.. Main Office 176 Doe Run Road-Manheim,PA 17545 MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL Panel Board No.............................Cert. o................................Cut-in Card No....................... ....... .. //��,, N_ 6 9 417 � Owner............. ........../1....!417 Q . Location.. ' /U�tJ S/!' /�� ....�f..r.... .......... 1...�-.�............... ........................... .......................... ............... ........ .... ...... Installation Consisting of.....5.. .G �� ........................•••••. ............................................ . ................................................J9.........../�........ ..................................................................................................... ................................... ..... .............................. InstalledBy.........�.`.............................. .....-...............................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 ctions at any time, and if its rules are violated,the Company shall have the right to-rev a th rt' ate. �' Q� Date.................................................. INSPECTOR... . ....... .......................................... ..................... Member N.F.P.A..LA E.I. Z�OC� TOWN OF QUEENSBURY BUILDING &_CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518)761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Location Z'-1 ��tJi.�`�6►.DF Date 00 a 1.-CpPermi t # b— SOIL TYPE: Sand-Loam-Clay- _ Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length Length of each trench Depth of trenches Size of stone SEEPAGE PITS: Number.,- Size - t ft. x ft. Stone size PIPING: Size Type Bldg. . to T an,�-fib �- C Tank) , 6v ?� Dist. Box to field/Pith Openings Sealed? Yes No Partial LOCATION/SEPARd1TIONS `� Foundation to Tank feet Foundation to Abs,orpti0 feet Separation of Pits, — eet . Conforms as per P1 bt Plan es o LOCATION OF SYSTEM ON PROPER (circle one) , Front— t - Left Side - Right Side Nkrddle Front - Middle Rear F3FMENTS.:- RLpgo SYSTEM USE APPROVED: YES NO 110, Arrived: Depart �. B lding In peg b