2014-546 TOWN OF QUEENSBURY
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742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140546 Date Issued: Thursday, September 10, 2015
This is to certify that work requested to be done as shown by Permit Number P20140546
has been completed.
Tax Map Number: 523400-279-018-0001-027-000-0000
Location: 71 SUNNYSIDE EAST
Owner: THOMAS & SYLVIA DOUGHER LE
Applicant: THOMAS & SYLVIA DOUGHER LE
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 /j
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property owner of the responsibility for compliance with Site Plan,
�d
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
Fay 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140546 Application Number. A20140546
Tax Map No: 523400-279-018-0001-027-000-0000
Permission is hereby granted to: THOMAS & SYLVIA DOUGHER LE
For property located at: 71 SUNNYSIDE 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 Value
Owner Address: THOMAS & SYLVIA DOUGHER LE
DARLEEN DOUGHER Septic Alteration Residential
71 SUNNYSIDE EAST Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
GEORGE DRELLOS 792-7257
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2014-546
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, October 29,2015
(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 o ue bury; Wed' t 1 y, October 29,2014
SIGNED BY 41
for the Town of Queensbury.
Director of Building&Co.e Enfor ement
•
•
'4 Office Use Only
Town of Queensbury Building & Codes Received:
SEPTIC DISPOSAL PERMIT "' 21V ax Map ID. QJ ! 11
` '• Permit No.: Fj
A permit must be obtained before beginning construction Permit Fee: $ `7 t,�
Approvals:
Applicant: ///DM Yr ( Installer/Builder /''y 7A-1"- _ feed«' JC1 'C
Address: 7 —Sul''j sie(e.. /_A S t Address /0 - xP.2 re
CJ2Gl e N"-JQ c� � �-/ -s 7-4 f/c , /I. /2.:(-0/
Phone: r 9 a S O 2 Z Phone 9d—72J7
Owner: Location of Installation 77 S Up--/) fide
Address:
Phone //��
Contact Person for Building&Code Compliance: (�-C4 ye
pr�//f Day Phone: Y76--.574‘c)
Residence information:
Year Built #of Bedrooms 3 x Gallons per bedroom =Total Daily Flow
1980 or older x 150 = Garbage Grinder installed?
1981—1991 A x 130 = 3 90 Spa or Hot Tub Installed? ND
1992—Present x 110
Parcel Information:
Topography -Flat Rolling Steep Slope %Slope
Soil Nature v4Sand tk Loam _Clay 011ier
Groundwater At what depth?
Bedrock/Impervious Material At what depth?
Domestic Water Supply Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate- per minute per inch(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 Planning Board approved subdivision).
Tank size 4.54-0 gallon(minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub
System Type: Absorption Field(with#2 stone) Total length o2Oz7 ft. Each trench / X zl
Seepage Pit(S)(with#3 stone) How many? Size?
Alternative System Bed or other type?
Holding Tank System Total required capacity? Tank size? #of tanks?
NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified Electrical form
on Town website; 2) Effective as of March 23, 2006 Septic System-As Built Plot Plan: The Building Department will no longer allow systems to be
covered until such time as an As-Built Plot Plan is received and approved by the Building Inspector. The installed system must match the septic system
iayout on file. There will be no exceptions.
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.
Print Name: Date: —2f
Signature: Date: //: ' 2 — /e"
Town of Queensbury Building&Codes Septic Disposal Permit 518-761-8256
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Town of Queensbury Building & Code Enforcement if ;,3b
Office No. (518) 761-8256
Septic Inspection Report
Inspection request received:
Name: Lis,he-r Inspected on:
Location: �` �( , \ L Arrive: : / a_xu.-?..
Permit No.: [ '‹I (o Inspector's Initials:
C•'�' ents and/or diagram
Soil Ty : San ay
Type of Water: Municip ell —
Waterline separation distance ft.
Well separation distance 1 I 2 ft.
Other wells: 1 o C.: ft. -t—
Well
frWell Casing Length 50'+/- Y_N_N/A
[150'to well required if NO]
Absorption Field: Total length .Zoj? ft.
Length of each trench
Depth of trenches Z ft.
Size of Stone *t Z
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank C .A T 41- ,-,‘ t
Tank to Distribution Box y i'Distri
Openingion Sealed ox to Field I Pit NLi. t �� -27,z,-- T o LC'
End Cap ✓✓Y N
Inlet/Outlet Pipes&Baffles
Manholes 12"or less below grade
[provide extension collar if Yes] _tce
Location/Separations
Foundation totion ift, ft.
Foundation to absorption 1.1-17 ft.
Separation of Pitsft.
Conforms as per Plot Plan . Y_N
Engineer Report and As-Built Y N
ETU Maintenance Contract provided Y N
Location of S stem on Prose •
Front40109 eft Side •ight Side Middle Front Middle Rear
S stem Use Stat19
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report