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2001-555 TOWN OF QUEENSBURY f 742 Ba Road ueensbu NY 12804-5902 518 761-8201 � v ,Q rv, ( ) Community Development - Building.& Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20010555 Date Issued: Friday, August 03, 2001 This is to certify that work requested to be done as shown by Permit Number P20010555 has been completed. Tax Map.Number: 523400-279-017-0002-009-000-0000 Location: 122 SUNNYSIDE RD.NORTH Owner: JON & SUSAN DOUGHER Applicant: JON& SUSAN DOUGHER 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 tpi 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20010555 Application Number: A20010555 Tax Map No: 523400-279-017-0002-009-000-0000 Permission is hereby granted to: JON& SUSAN DOUGHER For property located at: 122 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: JON& SUSAN DOUGHER Septic Alteration Residential 122 SUNNYSIDE NORTH Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/ Address Electrical Inspection Agency OUEENSBURY SEWER JAY SWEET Plans &Specifications 2001-555 SEPTIC ALTERATION PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Tuesday,July 23,2002 (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 of Q ns ury• hnda ,July 23,2001 `4 SIGNED BY c_P for the Town of Queensbury. Director of Building&Code Enforcement • ' Application for Permit — Septic Disposal System Towl1 of Queens.buly 742 Bay Ruud Queeusbtu;y, NY 12804 (518) 761-8256 1, OWNER INFORMATION: Office Use Location of installation: / v at.h h l .Si .,2 /v ' Filo i'onnit No. I)—5 5 Tax Mnp No. / / Ln Foe Paid act Owner's Name: �) 0 /U • 3—t,�S a ti "'Doug . Address: / -6 i.,u,1*.tn.<f `c; , /tJ 2. INSTALLER'S NAME : ("fk ),(2O 1 kitf\� PHONE NO. 3, RESIDENCE INFORMATION: (circle year of ng, Irdicale #bedroom(s) and multiply ii q CEI VEE bedrooms with applicab a gallons her hedruoltr to equal Io(u1 daily flow) JUL 1 S 2001 Yoar of House: No. of I3odrwotLs x Compujatiou = Total Daily Flow TOWN OF QUEEN BUILDING AND CODE x 150 gal/burin = 3 ---6 1980— 1991 x 130 gal/bdrnl = 1991 —present x 110 gal/bdrin = Garbage Grinder Installed yes k:Ig) Spa or Whirlpool Installed yes / 0 ; s 4. PARCEL INFORMATION: (circle applicable information & indicate measurements) • IO1.1941Uu ply .S •1.Nattr.tc_ . . .Cl.rvonct.Wntot_. _u.oskock..or..ilnporyjvu5_M.a.tor.iAil_ _Donteslic_Watvr.Supply /`T� rrl who/depth rrl who/ depth /mmialprrlf ak, Rolling loan: feel _feel Steep slope _clay — — if well; water supply ,__%slope other from any septic-system depth: absorption is fl, other ' Percolation Test; (To be completed by licensed professional engineer or architect) Rate: A• minute per Inch 5, PROPOSED SYSTEM: For New Construction: All Individual sewage disposal systems must be designed by it licensed professional engineer or architect (unless Installed in a Planning ilontd approved sutxlivision), Add 25(1 gallons to the site of the septic tank and leach field for each Garbage (hinder, Spa or Whitlix)ol Tub. . Septic Tank:f<frerp gallon (min. size 1,000 gal.) Tile Field: each trench fl, Total System Length: ft• Seepage Pit(s): number of size vf•each: ft. by fl, . Size of Stone to be used: ll ,____ ,__r, / depth m'thickness „__..._,_._...._..pet Bed System Size: x Alternative System: � nth and/or size l b — 2 Z 6, HOLDING TANK SYSTEM: (if required) Number of tanks: / Sizo of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associatod•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 Quoonsbury, 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 or an applicant, shall be void. . I have rend the regulations with respect to this application Hitt agree to abide by those and all requirements of the Town of Qucensbury Sanitary Sewage Disposal Ordinance. , 0 '1/4 --L.A /S 7- /- - / . Sig -atu a !responsible person Date TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name C-1V- F0-: l Location S1��-A(\_..tom\�`61n __ Date ` -j-OI Permit # Zz ) 15-C SOIL TYP Sand- am-Clay- Results of Percolat'on T.st- (if applicable) Rat -Minu ,e/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Le' gth 4r) Length of each tren4 h . -7;_e?� 77/7)1 Depth of trenches I - Size of stone `s., ! � SEEPAGE PITS: N mbeW' Size - ft. ft. Stone size PIPING: Size Type Bldg. to Tank U Tank to -Dist. Box s<< Dist. Box to Field/Pi ' Openings Sealed? AP No . .Part a.l LOCATIOd/SEPARATION : • El� Foundation to Tank t 0 , feet Foundation to Absorption feet - Separation of Pits _ feet Conforms as per Plot P1 a Ye No LOCATION OF SYSTEM ON PR PER . (circle one) Front - Rear - Le Si : Right Side Middle Front - iddle Rear COMMENTS: ULC SYSTEM.USE APPROVED: YE NO Arrive :1 Depa ed ' Bu ding In "car groo TOWN OF QUEENSBURY M BUILDING &_CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 � (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name C6 t\i--)PlIC. D C =JR Location _ \\5 Date (a— I —01 Permit # ___ KKE_ 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 - ft. x ft. Stone size PIPING: Size Type Bldg. . to Tank Tank to Dist. Box Dist. Box to Field/Pit Openings Sealed? Yes No Partial LOCATION/SEPARATIONS: 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: .� \16 i���\ FFR �t���� 1k ARAy0 BR (Wi ED0' � '1+i SYSTEM USE AP Oil D: YE Arrived: (1'..cx:) Departed: ui ing Inspe r