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2014-635 Albk TOWN OF QUEENSBURY Fit* 742 Bay Road,Queensinny,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20140635 Date Issued: Wednesday, December 17, 2014 This is to certify that work requested to be done as shown by Permit Number P20140635 has been completed. Tax Map Number: 523400-301-013-0001-036-000-0000 Location: 17 BRONK Dr Owner: MARK & DONNA POLVERELLI Applicant: MARK & DONNA POLVERELLI 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 (' A property owner of the responsibility for compliance with Site Plan, VVV ,45;it 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 12804-5902 (518)761-8201 ,14 jjj Community Development-Building& Codes (518)761-8256 BUILDING PERMIT Permit Number: P20140635 Application Number. A20140635 Tax Map No: 523400-301-013-0001-036-000-0000 Permission is hereby granted to: MARK & DONNA POLVERELLI For property located at: 17 BRONK Dr 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: MARK &DONNA POLVERELLI Septic Alteration Residential 17 BRONK Dr Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2014-635 Res. Septic alteration • $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,December 15,2015 (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 ue sbury• to' i yf P ec•_mber 15,2014 SIGNED BY - � for the Town of Queensbury. Director of Building&Code Enforcement f Community Development Office Town of Queensbury • 742 Bay Road • Queensburyw rk •12804 EEC II 3 l(�1` Office Use Only L/ TAX MAP NO. , ?Of. 15`/ J 36' PERMIT NO. / /`'"(V 35 PERMIT FEE 'Cj f 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. N l P T p -{I, OWNER: i 1Cj '�\`�' Q I V e I l \\ ` INSTALLER: .J— S S 1. i C ADDRESS: 1 1 ,rQ n 1< c) r ' ADDRESS: C0 We l-- qV" '�( 1 f`5 PHONE NOS. 7' 1-1- (.-t-\1 PHONE NOS. —I1 - 1 1 LOCATION OF INSTALLATION: 11 P)(t)n\ 0 ( RESIDENCE INFORMATION: NO.OF COMPUTATION = TOTAL DAILY FLOW YEAR BUILT BEDROOMS X (Gallons per bedroom) NARBAL GRJNE)ER 1980 or older I V N X 150 = \U l"� I I 1981-1991 X - 130 = 3 !n INSTALLED?PAOR OU?L 1992-present -.)? X 110 = 1 PARCEL INFORMATION: / ✓ TOPOGRAPHY: FLAT ROLLI G �/ STEEP SLOPE %SLOPE\\I IA- ✓ SOIL NATURE: SAND l LOAM V CLAY\V 1\ OTHER\Y ✓ GROUNDWATER: AT WHAT DEPTH? \1I \ ✓ BEDROCKIIMPERVIOUSMATERIAL: AT WH DEPTH?\\I I� ✓ DOMESTIC WATER SUPLY: MUNICIPAL V WELL (If well:water supply from any septic system absorption is:, ft) ' ✓ PERCOLATION TEST: RATE IS \ 1\ PER MINUTE PER INCH[mpi] (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: `'t) 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: 1 l MABSORPTION FIELD(WITH NO.2 STONE) Total length - )0 ft. Each trench I) X t-I'0 ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? N- Size? \V 1* ❑ALTERNATIVE SYSTEM Bed or other type? \ ❑ HOLDING TANK SYSTEM Total required capacity? If h-- `\Tank size? 1 i )\ Number of tanks?V I\ NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL INSPECTION AGENCY- PLEASE REVIEW LIST PROVIDED. 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 an•. :II requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL Sanit. S:0..1• ' sposal Ordinance. r codes( oueensburv.net Signat P/rson Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION www.ciueensburv.net Town ói Que€i'isbury Building &Code Enforcement (,(fed ,0 Office No, (518) 761-8256 Septic Inspection Report Inspection request received: Name: P O & TL I I( Inspected on: /a- i/. Location: P7fib r00 f< Arrive: 0AIWA/ •.m. Permit No.: / L3 5 Inspector's Initials: 11,1 ` omments and/or diagram Soil Type . .. i Clay Type of Wat- . u.ici.4A • Water > 00 to Waterline separation distance ft. Well separation distance _____L—ft. Other wells: / ft. Well Casing Length 50'+I- Y N N/A (150'to well required if NO] Absorption Field: Total length 2./..)D ft. !^! , T ttke i1. Length of each trench 5 ft. `' i Depth of trenches ?..-1 _3_ ft. Size of Stone 41'-2_ Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank L1" iiCH 80 Tank to Distribution Box 14" i c R Distribution Box to Field I Pit y _hV)R 9). To L---‘11 1j 5-- \)C9F, Opening Sealed: N End Cap N Inlet/Outlet Pipes&Baffles ‘ N Manholes 12"or less below gradeY fid' [provide extension collar if Yes] _Y N Location I Separations Foundation to tank t ft. Foundation to absorption 217 ft. Separation of Pits ft Conforms as per Plot PI N Engineer Report an As-Buil Y_N ETU Maintenance act provided Y_N Location of System on Property: - Front Rear Left Side Right Side Middle FrontMiddle Rear S stem Use Sta s: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report 4 We've The Leader 11..111, 6' F.W. WEBB COMPANY in Distribution Albany rs.=„is r.,.: ,t,, 'i- ri, t,---,.., x ,� Rli% "7" 17 Erie Boulevard i Albany,NY 12204 518.472.9322 800.432.9322 Fax:518.472.9399 - Binghamton 62 Griswold Street Binghamton,NY 13904 L , - - 607.724.3170 , ii , .., , 888.593.9322 Fax:607.724.4369 Clyde 80 Davis Parkway C Clyde,NY 14433 315.923.7819 800.828.8824 Fax:315.923.3794 z, N Plattsburgh 7327 Rte 9 x Plattsburgh,NY 12901 (+jfie518.562,2575 800.622.9322 c Fax:518.562.01 17 ��) r L/) .a Queensbury �; L 3 Highland Avenue 1`` Queensbury,NY 12804 5- ^J y;' 518.792.1316 /\ ,� ,` 800 .826.0326 1:,) Fax:518.792.1335 I J\ 'n h f ';14 Syracuse 1S I` J • 158 Syracuse Street 1Syracuse,NY 13204 315.476.9322 �-1 Z D 800.262.9222 N Fax:315.472.4139 ,\ `^ .,..t� Utica \ >, +,,., ` 415 Broad Street \ 114 ;Y Utica,NY 13501 t @ a 315.724.3191 C) Fax:315.724.4067 New Jersey Office: 973.696.0745 Fax:973.696.0680 JYORK° Masoneilan •XOMOX � V1ega spira�csarco TYLLIC w BRADFORD WHITE 'ADA*A 4* ✓ � G`r• �p� fillings&Valves RIDGID Johnson ��)�� p3M �' �,»Za�Z. �� u�� • Controls Honeywell ASCO l ®leris AHEAD ()I Ulf NOW CRANE �taulic• NIBCO �•ASHCROFT ITT 9 4 r \0 ri" ' \ LI-o O /'-9--- .,-: },! L� ri"E • �0 �61 SEPTIC PLOT PLAN 4-(r 16' e I HAVE SEEN OR OBSERVED ALL OBJECTS SUCH AS HOUSES, WELLS, TREES, FENCES, ETC 1 SHOWN N THIS DOCUMENT.I HAVE PERSONALLY I e- .15-11^6) 11.10 1 r ME SI ANCE SET FORTH ON TITSDIA � 117 slaw- DATE DO r r\cji Pc \ vce \ TOWN OF OU: 1 'LB J, \IN Dr . BUILDING I ' �'�'`` j C :(-). Reviewed By 04,,, Date: r -71+4- ` S`t Ir et. c7 ( \'‘K. 0 . r iv, \v " o i I I I (-o K p( . ( ( (