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2002-117 TOWN OF OUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building& Codes (518)761-8256 CED"IFICATE OF COMPLIANCE , Permit Number: P20020117 Date Issued: Fri'day,March 15,2002 This is to certify that work requested to be done as shown by Permit Number P20020117 has been completed. Tax Map Number: 523400.279.017.0001.061.000.0000 Location: 165 StWSIDE Rd Owner: JOHN&MARY ELLEN REESE Applicant: JOHN&MARY ELLEN REESE This structure may be occupied as a: By Order of Town Board Septic Alteration Residential T6v N'".oV.QUEBNSBURY 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 4 BUILDING PERMIT Permit Number: P20020117 Application Number: A20020117 Tax Map No: 523400-279-017-0001-061-000-0000 Permission is hereby granted to: JOHN&MARY ELLEN REESE For property located,at: 165 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 incompliance with the NYS Uniform.Building Codes and the Queensbury Zoning Ordinance. T"e of Construction Value Owner Address: JOHN&MARY ELLEN REESE Septic Alteration Residential 165 SUNNYSIDE Rd Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name Address Electrical Inspection Agency QUEENSBURY SEWER JAY SWEET Plans &Specifications 2002-117 SEPTIC ALTERATION AS PER APPLICATION $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,February 25,2003 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the To nueens ty; Mo a February 25,2002 SIGNED BY for the Town of Queensbury. Director of Building&Code nforcement Application for Permit—Septic Disposal System Town Of Qtaeensbuty 742 Bay Road Quee[isbwy,NY 12804 (518) 761-8256 1. OWNER INFORMATION: _........................................................................................_............._ ....._........... 1 / { Office Use Location of installation: File Permit No -�,;2-"I Tax.Map No. I I E gip' -Fee Paid.��Y ;E Owner's Name- -,U y y Q ...........:...:...................._........................._.........................................I................... Address: FEB -2 F; 20G2 i 2. INSTALLER'S NAlYiE TOWN OF S. Y Ot' PHONE NO. BUILDINGI AND CODE 3. RESIDENCE INFORMATION: (circle year of.dwellinga #bedrodn[(sjd ultipiy#ofbedrooms with applicable gdler=$edroom to equal total dailyJlow) _ Year of House: No of Bedrooms x Computation = Total Daily,Daily, Flow 1980 or older _/ x A50-gal/bdrm 1980= 1991 x ,1:30,gal/bdrm = 1991 -present G x l 10 gal/bdrm = Garbage.Grinder Installed yes— kio-' Spa or Whirlpool Installed yes_ 1 f� 41. ' PARCEL INFORMATION: (circle.applicable information&indicate measurements) Topos raph Soil Nature ' Ground Water Bedrock or Inn ervious Material Domestic Water Supply Ala[ _rid=' at what depth at what-depth = rnzsn[cillal Rolling - � loam fee[ fee[ we Steep slope clay if well; water supply Yo slope other from any septic-system _f_t_-_._. other. . _ Percolation Test: (To be completed bylicensed pruferr oticrI engineer or architect) - Rate: minute per inch 5. PROPOSED-SYSTEM: For New Construction: All individual sewage disposal systcros.must be designed by a licensed professional engincer or archite'cl(unless installed in a Planning Board approycd subdivision). Add 250 gallons to the sine of the septic tank and-leach field for each Garbage Grinder :Spa or Whirlpool Tub. Septic Tank�Q--:�,r/ gallon[ (min. size 1,000 gall Tile Field: each trench ft. Total,-System Length: Seepage pit(s):, number Of size of each: _:JI •by Size of Stone to be used: iI / depth or thickness feet Bed System Size: x Alternative System:l 44, (-t y-a' c,-!c .S length and/or size ea,gz 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 tlio 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 belxalf 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. 'at�re f responsible person -Date i +J 4� 4J a N 0 (v ro p 4. 4: w C c: I ' N o Li Z {� w �. 0m U � t va -P 4). u % I po �o QI J C t;S# Q1 41 U LU r,IW � � s. � .� � � 0a WO E v O.Yaof-S 4-"0OM QE W W U� 1 a 0 4 a s C�. ro.0 J 0 { Juld ° C W -C U IL N { N t�. cn aAM�. 0 0 cvi c � ro� 4J � a 4J. Iwro0 N �. aM m 04J OW 0Wc 4- U +) 4 H Q1 I-. .�, V) (A Iw C C (Qa W ' m W a' 4- 4 N c x N a a U r. I ro m 0 t� or a 0 0 47 'P-r ►r 0 !L w) � 1 4J 0.0IL -C 00 t C� - ,cry it � E � � tL r� �f # .0 4$ r�" + -r 113.'0 S. a U P r- . ! N (0 v W WC0)4J OIL 0) C* 0).� 4JC4CC04- � C-0 rl U H 04-11iI) CGINWN00 '0CWQlU :3 :3aC U t- 0-0 X 4 J © V1 IY v „jy W'�Vw'1 'tw k� ttf'r (10 a a 0 Q 0 L S. -r- 0 f c POP amo: LU4 Ly R LLI o � TOWN OF QUE . . BURY UILDIN6& f a PT, fi EVIEWED 13Y 1' ATE Z° .0,1 , fo Ca "I have seen or observed or believe I saw evidence of vo m , � ; all objects such as houses,wells,trees,fences,etc,,, z° p � shown-on this-document, I also represent thit'I Piave Ae~ �. a zm r� personally measured [lip distances set forth on the diagram." o O o m� SIGNATURE SATE