SEP-0737-2018 imok,
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-0737-2018 Date Issued: Friday, November 30, 2018
This is to certify that work requested to be done as shown by Permit Number SEP-0737-2018
has been completed.
Tax Map Number: 295.17-1-46
Location: 9 PINEWOOD HOLLOW RD
Owner: Kelli Hatin
Applicant: Kody Kristel
This structure may be occupied as a: Residential Septic Alteration
Replacing leach field and D-box By Order of Town Board
(tank remains) TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the 4
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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: SEP-0737-2018
Tax Map No: 295.17-1-46
Permission is hereby granted to: Kelli Hatin
For property located at: 9 PINEWOOD HOLLOW 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: Kelli Hatin Septic Disposal-Residential $0.00
Owner Address: 9 Pinewood Hollow RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Kody Kristel
9 PINEWOOD HOLLOW RD
Queensbury,NY 12804
Plans&Specifications
Residential Septic Alteration
Replacing leach field and D-box
(tank remains)
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday,November 27,2019
(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 sbury; 4Tu, a ber 27, 2018
SIGNED BY: I for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only
742 Bay Road,Queensbury,NY 12804
town of(Ztccnshutz p;518 761-8256 Permit#: 7�7- / g
Tax Map ID#: 2-5, I? -- I - y 6 Permit Fee: $ 75 ; Invoice#: !Oka b
Project Location:
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I Pin�uoo^^� Mo l�o:� LYid y/ � Septic Variance? Yes No
Primary Owner(s) fl e-I 1 i /-1441p,
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Mailing Address q p;neLicoc► Ho O o,,i loc+c(
Phone & Email $It5 -225 - SI ZS Kell J �- L f
e , k �� c1/'uri iCO!'h
Installer/Builder X� Kr'iS/ ✓ ;/
Mailing Address y q J --l.1641
o I �soc►E .
144.61
Phone & Email 5/ l- -?016 - 160 X rk I Kcc @,yv;I.con-. Ir L V ' '�
ILE
Engineer n
Mailing Address Ei NOV 2 1 2018
Phone & Email TC;9a , , •= , -
NSBURY
Contact Person for Building&Code Compliance: K OCJ }i 5re_l done -to s ��
RESIDENCE INFORMATION: /
Year Built Gallons #of bedrooms X gallons per =total daily flow
per day bedroom Garbage Grinder Yes Nl
1980 or older 150 Installed? (circle one)
1981-1991 130 3
Spa or Hot Tub No
Installed? (circle one) 6)
1992-Present 110 II Q.1/0-i-aiiacAeci • 5e fAc)
PARCEL INFORMATION:
Topography 1 Flat Rolling Steep Slope %Slope
Soil Nature ,1 Sand Loam Clay Other
Groundwater At what depth? ?
Bedrock/Impervious material At what depth? A724
Domestic Water Supply ~-1 Municipal _Well (if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: ? per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size ? gallons(min.size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length "ZC�O ft.; Each Trench SO ft.
Seepage Pit with#3 stone How many: ;Size:
Alternative System Bed or other type:
Holding Tank System Total required capacity? ;tank size ;#of tanks
NOTES: 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-built plan is received and approved.
The installed system must match the septic 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 known by or on behalf of an applicant,shall be void. I
have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage
Disposal Ordinance.( ,(
PRINT NAME: KUcf,y Kris/el DATE: ,/Z I/N
SIGNATURE: // DATE: I I/Zi7/8"
Town of Queensbury Building&Code Enforcement Revised March 2018
. , s— 1 g --?q6— 160? r• ,
REVISED
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