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2003-904
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: P20030904 Date Issued: Wednesday, October 29, 2003 This is to certify that work requested to be done as shown by Permit Number P20030904 has been completed. Tax Map Number: 523400-279-017-0001-066-000-0000 Location: 179 SUNNYSIDE Rd Owner: FLORENCE TURNBULL Applicant: FLORENCE TURNBULL This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY -- I ) , ,e, Director of Building.&Code Enforcement ��` TOWN OF QUEENSBURY fA742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20030904 Application Number: A20030904 Tax Map No: 523400-279-017-0001-066-000-0000 Permission is hereby granted to: FT ORENCE TT TRNRT Tf,T, For property located at: 179 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: FLORENCE TURNBULL 179 SUNNYSIDE Rd Septic Alteration Residential Total Value QUEENSBURY, NY 12804 Contractor or Builder's Name /Address Electrical Inspection Agency OTTEENSBTTRY SEWER JAY SWEET Plans&Specifications 2003-904 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, October 29, 2004 (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 them of Q nsl ; . ednesday, October 29, 2003 SIGNED BY � ,r/ � , for the Town of Queensbury. ' \, Director of Buil.ing&Code Enforcement Application for Permit=Septic Disposal System Town of Queensbury 742 Bay Road Queensbuy,NY 12804 (518) 761-8256 1. OWNER INFORMATION: p • Office Use Location of installation: ( 7! vt�/4 1S't (y L File PermitNo. - Tax Map No. / / �- Fee Paid Owner's Name: . r�dv�!1 Address: / 7 d1 OCT 2 $ 2003 TC"WN OF OU FN a•'3"1 RY 2. • INSTALLER'S NAME : Ca0/4C__ C BUILDINGAND CODE �O PHONE 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 1980 or older Z x 150 gal/bdrm = 39.4 1980— 1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrin = ��— Garbage Grinder Installed yes / no Spa or Hot Tub Installed yes_ / no 4. PARCEL INFORMATION: (circle applicable information&indicate measuremen ) Or— Topography Soil Nature Ground Water Bedrock or Impervious Material . Domestic Water Supply Flat sand at what depth at what depth municipal Rolling feet feet well Steep slope clay if well; water supply %slope other from any septic-system depth: absorption is 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: %d40 gallon(min. size 1,000 gal) Tile Field: each trench ft. Total System Length: ft. Seepage Pit(s): number of size of each: ft.'by ft. Size of Stone to be used: .# / depth or thickness feet Bed System Size: 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 misrenrecen+a+in„ nr fa;l„r,+n c,.« ._ '`WNW. ,,''' l'aivn 'of (Zttt;t+,rtstl}tit-y , Sgwca•:3 stncl Sowiij;c: I)isperstl eltstpI. r • Al�pontlix e • ' • • A'1i•;it)ItYI"�I'I()N •I 11;11J1•) ' SE1'/11ti.VI'1W1'4 ltlAll.)IItitMPINTS • l ins, F�QND r?,1.110,61 . •nq,ttT CAST►IC; '' • . / I... /// . .' 47 /\'' • 1 4 •,'� 14iir It.• titIOt•13C G c%E - , �,10)'• Ilovsa_ G • E ((7b ,. w• .. 121-1 . L- 7 ' e' i / • Sct�tic. • 1 \ " ../ iCellI) . .. . L. F.1IAMI, ' • • • -- ttant/ • 44 "e•""e.r• Y • • / • • Y • &INFORMATIOI"t PM' F6DWxsL4 x'pr zvari �y c"...• .-, • ; 'A.::r 7Y SIGNATURE • • • • Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: • Queensbury Building&Code Enforcement Arrive: am/pp Depart: • am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: fe,e..---- NAME: Q v L-L— PERMIT NO.: 03 — 4ri0/ LOCATION: 17 U N . 6k t CY.). INSPECT ON: o Q1 o ' RECHECK: . Comments and/or diagram Soil Type: ,and/Loa , ay Type of Water: i nicip /Well Wat ,/� J Waterline separation dista ce S"`'ft. /4-ifiK 61C",ZA„Ce,� -Ail Well separation distance ft. Other wells: ft. �N�GI v Absorption Field: Total length ft. Length of each trench — ft. Depth of trenches - _ ft. Size of Stone Seepage Pits: Number _ _ _ --- s.A F-FC C' — O K Size: x Stone Size: Piping Si` D., Type /, Building to tank 47,e 4 ei /{-'/') Tank to Distribution Box Distribution Box to Field/Pit Opening Sealed: Y/N/Partial Location/Separations Foundation to tank ft. Foundation to absorption ft. 'Separation of Pits ft. Conforms as per Plot Plan Y N Locatio o stem on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Stt: ✓ Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved "I have seen or observed, or 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." • • SIGNATURE DATE _________ — — ----:______ _ . TOWN OF C JE ...N3°:pUR . /� BUILDING ,=gip T.'J eA) (Jl REVIEWED BY DATE e . - flr' �Q©o • A `l� S �c D . . • �U.�/ it . .