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BOTH-000414-2015 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 i Community Development-Building& Codes (518)761-8256 CERTIFICATE OF COMPLIANCE Permit Number: BOTH-000414-2015 Date Issued: Monday, December 14, 2015 This is to certify that work requested to be done as shown by Permit Number BOTH-000414-2015 has been completed. Tax Map Number: 308.19-1-39 Location: 19 PINELLO RD Owner: BURTON BARBER Applicant: This structure may be occupied as a: Residential Septic Alteration By Order of Town Board TOWN OF QUEENSBU/R�Y Issuance of this Certificate of Compliance DOES NOT relieve the ®J % � 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 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: BOTH-000414-2015 Tax Map No: 308.19-1-39 Permission is hereby granted to: IBS Septic For property located at: 19 PINELLO 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 Owner Name: BURTON BARBER Septic Disposal SlLno Owner Address: 19 Pinello RD Total Value .50.00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency IBS Septic 2 WARREN ST Glens Falls,NY 12801 Plans&Specifications Residential Septic Alteration $40.00 PERMIT FEE PAID-TMS PERMIT EXPIRES: Thursday,December 8,2016 (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 exxp�:ration date.) Dated at the Town ueens [ / /�Mo er 14,2015 SIGNED BY: L•iVJXr/ �•VJ for the Town of Queensbury. Director of Building&Code Enforcement Community Development Office S1 Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 Office Use Only TAX MAP NO. n�� ] I ��I PERMIT NO PERMIT FEE 0 APPROVALS: ZONING -� TOWN CLERK S V - 1('p I APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT; A PERMIT MUST BE OBTAINED BEFOREg RK I GINS. APPLICATION IS SUBJECT NO REVIEW��BEFORE ISSUANCE OF A VALID PERMIT. OWNER: �UJJ 11II IDD S� Ty� '/{/� c ADDRESS Q�r n ADDRESS L ( _V A r J�- PHONE NOS. U — `U 0 PHONE NOS. LOCATION OF INSTALLATION: I!� RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS Gallons per bedroom GARBAGE GRINDER 1980 or older X 150 = INSTALLED? 1981 -1991 X 130 = 44� SPA OR HOT TUB 1992-present X 110 = INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROL G STEEP %SLOP ✓ SOIL NATURE: SAND JH Me CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? ✓ BEDROCK/IMPERVIOUS MATERIAL: EPTH? DOMESTIC WATER SUPLY: MUNICIPELL (If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS� PER MIINUTE PER INCH[mpg (Test to be completed by a licensed professional engineer or architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: All irYcividual sewage disposal systems must be designed by a licensed professional engineer or architect(unless Installed in a Planning Board approved subdivision). TANK SIZE: 1111 GALLON ,]N.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder, spa or whirlpool tub. ell l SYSTEM TYPE: x\ ❑ABSORPTION FIELD(WITH NO.2 STONE) Total length H. Each trench� X J ❑ SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size? o ALTERNATIVE SYSTEM Bed or other type? V ❑ HOLDING TANK SYSTEM Total required capacity? Wk ank size?=Number of tanks? 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 applicgaabon and agree to abide by these and a reAuirements of the Tow n of Queensbury QUESTIONS? CALL 761.8256 OR EMAIL San'a e I al Ordinance. IIL 1 codesOgueensburv,net VISIT OUR WEBSITE FOR MORE INFORMATION Signature of on Responsible Date www.gueensbury.net I -E CO i - I-- o q do S e 7o 7,1,c//< i/udSe •—o -D .73�.ro�c 712V A( //19 Of Tv r)rT cv I,IpJS�i 1, d o i QCd"P f.35' T> x