2010-358 alkak TOWN OF QUEENSBURY
FON 742 Bay Road, NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100358 Date Issued: Friday, October 18, 2013
This is to certify that work requested to be done as shown by Permit Number P20100358
has been completed.
Tax Map Number: 523400-279-019-0001-025-000-0000
Location: 185 SUNNYSIDE EAST
Owner: LACEY HAYES
Applicant: TRACY JAMESON
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 (--c•Dj
property owner of the responsibility for compliance with Site Plan,
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.
44 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100358 Application Number. A20100358
Tax Map No: 523400-279-019-0001-025-000-0000
Permission is hereby granted to: TRACY JAMESON
For property located at: 185 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: TRACY JAMESON
31 SUNNYSIDE EAST Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-358
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,July 26, 2011
(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 T c ee r)/ my 26, 2010
SIGNED BY \ for the Town of Queensbury.
Director of Building&Code Enforcement
OFFICE USE ONLY r
X79, 19-I-�5 � _`
Al7.35T
TAX MAP NO. PERMIT NO. PERMIT FEE L-3
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER: /s- LtG( Cc.l-)/ 6 SGdi /1/'
_.-- INSTALLER: f n t \r) SIRIC c PfrU
ADDRESS: / tJ St(017 576:1f' CcS
{ i (*()°\
ADDRESS:
C
PHONE NOS. �J % �v ` ' (*C PHONE NOS.
LOCATION OF INSTALLATION: / 3 �11/-)LI S I C/ /s'I-'( / 58-4,,r__ --
w
YEAR BUILT NO.OF / t C' '7 RESIDENCE INFORMATION:
BEDROOMS X COMPUTA ON= = TOTAL DAILY FLOW
1980 or older 3 X 150 gallon per bedroom = "450 GARBAGEINSTALLED?GRINI�) (JDER,
'•
1981 -1991 X 130 gallon per bedroom =
1992-present X 110 gallon per bedroom = SPA EDT TUB, r
INSTAALL LED? IV )
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling 1 Steep slope %Slope
✓ SOIL NATURE: Sand ✓ Loam
Clay Other
✓ GROUNDWATER: At what depth? ab
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPLY: Municipal Well ✓ (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is
per minute per inch.
(Test to be completed by a licensed professional engineer or architect.)
PROPOSED SYSTEM FOR CONSTRUCTION: All individual sewage disposal systems must be designed by
a licensed professional engi er r architect (unless installed in a Planning Board approved subdivision).
TANK SIZE: 1JD GALLON (MIN. SIZE IS 1,000 GAL.) Add 250 gallons to the size of the septic tank for
each garbage grinder, spa or whirlpool tub.
SYSTEM TYPE:
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length I r g) ft. Each trench 3 X (20
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many?• Size?
O ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity?
Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED'ELECT . .......................
..........._............... . . ..
NSPECT
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVEW LIST PROVIDEDED BY A TOWN
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, an.
permit or approval granted which is based upon or is granted in reliance upon any material misrepresentationy
or
failure to make a material fact or circumstance known by or on behalf of an applicant, shall be void.
•
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/p�jm9Depart: Oam/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: e'_
NAME: 4 ANK c.1 6 PERMIT NO.: /0 5 g
LOCATION: / jj et r to cj(C,rnc�tINSPECT ON: Ge91 Ce 1 a)
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft. 24 (1) -d -/
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: Y N
End Cap Y_N
Inlet/Outlet Pipes&Baffles _Y_N
Manholes 12"or less below grade _Y_N ' .,�'
[provide extension collar if Yes] Y N _`� ".�,
Location/ Separations ,t��y� �
Foundation to tank ft. "J"`� �)
Foundation to absorption ft.
Separation of Pits ft.
�
Conforms as per P a N
Engineer Report a As
u' Y N �(� -
ETU Maintena ract _Y N 6
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Sta s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Repori.03 29 10.doc
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: ( .M eS(on PERMITNO.: to -3 rJ
LOCATION: ' . . _ S ' . .c INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/Clay
Type of Water: Municipal/ Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' +/ - Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: Y N
End Cap Y N
Inlet/Outlet Pipes&Baffles Y N
Manholes 12"or less below grade _Y_N
[provide extension collar if Yes] Y— N
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan _Y_N
Engineer Report and As-Built Y_N
ETU Maintenance Contract _Y N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Irspectbon Forms\Septic Inspection Report_03 29 10.doc
/^ 3 itoi-&67,
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:,0
NAME: r►4o� v� PERMIT NO.: /O3'sF
.
LOCATION: 't: — .► • INSPECT ON: ?--24—/C,
RECHECK:
Alb Comments and/or diagram
Soil Type: • • / Loa Clay
Type of Water: Municipal/ V(eT( r
Waterline separation distance ft.
Well separation distance lok ft.
Other wells: .....
Well Casing Length 50' +/ - Y N _ N/A
[150'to well required if NO]
Absorption Field: Total length
Pa-p0 ft.
Length of each trench iii ft. ---- `~"
Depth of trenches ;4f I tC--
Size of Stone 1 1Z.— /C
-
Size
Pits: Number _ i[
Size: / '^
Stone Size: ‘
Piping Size Type N
Building to tank 4° :(! L IN
1-4
Tank to Distribution Box D. 1&114(-- _
Distribution Box to Field/ Pit
Opening Sealed: N 'L"
End Cap ‘, /____
Inlet/Outlet Pipes&Baffles _ C1)41
Manholes 12"or less below grade Y
[provide extension collar if Yes] Y N
Location/ Separations /42.1))&) :S
Foundation to tank L ft.
Foundation to absorption 4,, ft. /, '
Separation of Pits ft.
Conforms as per Plot Plan
Engineer Report and As-Built —Y—N Ci'
ETU Maintenance Contract _Y_ N
provided C2 -L'r?
Location of Syst-i• • Property:
Front Rear Left Side Right Side Middle Front Middle Rear
st-m Use S . s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Repork_03 29 10.doc
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TOWN OF OUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination,00mpliance
with our comments-thair not be construed as
indicating the plans and specifications are in I -
full complianoe with thb ieuaelog Coen of
New York State,
it ---e
1_, "I have seen or observed, or believe I saw evidence of,
all oblects such as houses, wells, trees, fences, etc.,
shown on tnis Qc.aurnent I also represent that I have
personally measured the distances set firth on the diagram."
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S f4ATURE 7 D-TE
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4V:ft. i THIS PLAN TO BE ON
'
_ PROJECT SITE AT
-ALL TIMES FOR
THE DURATION OF
CONSTRUCTION