BOTH-000150-2016 TOWN OF QUEENSBUR.Y
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building&. Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000150-2016 Date Issued: Thursday, April 14, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000150-2016
has been completed.
Tax Map Number: 308.12-2-69
Location: 29 STEPHANIE LN
Owner: Stephen Mastellone
Applicant: Stephen Mastellone
This structure may be occupied as a: Residential Septic System
By Order of Town Board
TOWN OF QUEENSBURY
i
Issuance of this Certificate of Compliance DOES NOT relieve the
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.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Wyd „ d
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000150-2016
Tax Map No: 308.12-2-69
Permission is hereby granted to: Sanitary Sewer Service
For property located at: 29 STEPHANIE LN
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
Owner Name: Stephen Mastellone Septic Disposal $0.00
Owner Address: Total Value $0.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Sanitary Sewer Service
PO Box 224
Glens Falls,NY 12801
Plans&Specifications
Residential Septic System
$40.00 PERMIT FEE PAID-TIES PERMIT EXPIRES: Friday,March 17,2017
(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 of ueensb uesd h 22,2016
SIGNED BY: W for the Town of Queensbury.
Director of Building&Code Enforcement
308.12-2-69 BOTH 150-2016
Mastellone
Sanitary Sewer- Drellos ecetve
(10
29 Stephanie Lane Res. Septic System T p I '�
_ Permit No
Gr -7 7 s� U�
r
LOCA vam OF imarULATION �� JA X'. � �� I uI��w �� ��; �
PPL mT e 1P� (h S I (f C( l� /✓� PHONE/E-MAIL
ADDRESS
/NSTAUARMULl7ER: S id l� �/� r / PHONE/E-MAJL
®FA(NER J��' /�lI/7� �CO i'-�- PHONE/E MAIL
Address
CONTACT P1eR90N FOR BUILOINS CODES COMIA ��O� �01 PHONE����/
REwI®EMG°E INF®RIPN.477®{U
Year Built #of bedrooms X Gallons per bedroom =Total Daily Plow
1980 or older �S"Qs(> Garbage grinder installed _Y N
1981-1991 Spa or Hot Tub installed _Y _N
1992-Present
PARGEL INFORMAT/ON
Topography Plat rolling Steep slope %slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth?
Bedrock/Impervious Material At what depth?
Domestic Water Supply _.L Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: / S per minute per inch(test to be completed by licensed engineering/architect)
PROPOSER SYSTEM FOR NEW CONS RUCT1®N
Tank Size gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with 42 stone Total length Z_--e 8 ' ft.;Each trench_x
-
Seepage Pit with#3 stone How many: :size
Alternative System Bed or other type?
Holding Tank System Total required capacity? Tank size #of tanks
motea: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer
allow systems to be covered until such time as an As-Bulft plan is received&approved. The installed system must match the septic system
layout on file—no exceptions.
DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or
failure to make a material fact or circumstance know by or on behalf of an applicant, shall be void. i have read the regulations
and agree to abide b�these and all r quirep)ents of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: f e-1101 Date: 3 - 7 ? -/6
Signature: Date: 3-2Z--1 �,
Town of Queensbury Building&Codes Septic Disposal Permit Jply 2014
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