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2009-373 TOWN OF QUEENSBURY 742 BayRoad,Queensbury,IVY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 E] 'PTIFICATEFMI'LI� E Permit Number. P20090373 Date Issued: Tuesday, August 18, 2009 This is to certify that work requested to be done as shown by Permit Number P20090373 has been completed. Tax Map Number. 523400-308-017-0001-015-000-0000 Location: 16 STONEBRIDGE Rd Owner. PETER& MARION POLICASTRO Applicant: PETER& MARION POLICASTRO This structure may be occupied as a: Septic Alteration Residential By order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DUES NOT relieve the ,_- owner of the responsibility for compliance with Site Plan property p tY P � ;,. Variance,or other issues and conditions as a result of approvals by the Director of Building&Cod Enforr went Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20090373 Application Number. A20090373 Tax Map No: 523400-308-017-0001-015-000-0000 Permission is hereby granted to: PETER&MARION POLICASTRO For property located at: 16 STONEBRIDGE 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 Value Owner Address: PETER& MARION POLICASTRO Septic Alteration Residential 16 STONEBRIDGE Rd QUEENSBURY,NY 12804 Total value Contractor or Builders Name/Address Electrical Inspection Agency MORNING STAR SEPTIC Plans &Specifications 2009-373 SEPTIC ALTERATIO RESIDENTIAL $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,August 18, 2010 (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 oTensb T s gust 18, 2009 SIGNED BY 4� for the Town of Queensbury. Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20090373 Application Number. A20090373 Tax Map No: 523400-308-017-0001-015-000-0000 Permission is hereby granted to: PETER&MARION POLICASTRO For property located at: 16 STONEBRIDGE 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 Value Owner Address: PETER&MARION POLICASTRO Septic Alteration Residential 16 STONEBRIDGE Rd S QUEENSBURY,NY 12804 Total value Contractor or Builders Name/Address Electrical Inspection Agency MORNING STAR SEPTIC Plans &Specifications 2009-373 SEPTIC ALTERATIO RESIDENTIAL $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,August 18, 2010 (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 To Queerury, Tu day,August 18,2009 SIGNED BY for the Town of Queensbury. Director of Building&Code nforcement %.......................... OFFICE USE ONLY. ..,-.._....___� f�---�����- �� + TAX MAP NO. PERMIT NO. �3 P RMIT FEE + + APPROVALS: ZONING U �09 ��� �U� TOWN CLERK + ..................................................... + RY' _____________ ._ SOWN OF Ql APPLICATION FOR SEPTIC DISPOSAL SYSTEM PE 'ILDING & (',ODESys, A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: INSTALLER: ADDRESS: 6 f a-aal0-`j, ADDRESS: /02 PHONE NOS. 9 �' I 2 PHONE NOS. '293 22,t 0 LOCATION OF INSTALLATION: /U SG RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION= JI = TOTAL DAILY FLOW BEDROOMS GARBAGE GRINDER 1980 or older X 150 gallon per bedroom INSTALLED? 1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB 1992 present X 110 gallon per bedroom = INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat rolling_ Steep slope %Slope ✓ SOIL NATURE: Sand Loam_ Clay Other ✓ GROUNDWATER: At what depth? 6 r f- ✓ BEDROCKAMPERVIOUS MATERIAL: At what depth? ✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic system absorption is r n o ft.) ✓ PERCOLATION TEST: Rate is per minute per inch. (Test to be 6mpleted 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 cpau 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 1' ft. Each trench- X _ ❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size? ❑ ALTERNATIVE SYSTEM Bed or other type? ❑ HOLDING TANK SYSTEM Total required capacity? Tank 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 circumstancA knnwn K, ---- k^6-" -- ---- - " ' Septic Inspection Report Office No. (518) 761-8256 Date InspectionV iv Queensbury Building &Code Enforcement Arrive: a pm 742 Bay Rd., Queensbury, NY 12804 Inspector's In NAME: �L : — LOCATION: [ w �D RD : Z— — RECHECK: Comments and/or diagram Soil T n a Type of Water: Municipal ell Waterline sea n istance ft. Well separation distance �ft. Other wells: ft. Well Casing Length 50' + - Y N A Absorption Field: Total length ft. Length of each trench c✓ ft. Depth of trenches Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank q A I sJ Tank to Distribution Box Distribution Box to Field / Pit is Opening Sealed: N End Ca N Inlet/Outlet Pipes&Baffles Y N Location Separations Foundation to tank Foundation to absorption Separation of Pits ft. Conforms as per Plot Plan Y_ N Engineer Report and As-Built Y N Location of System on Property: Front Re Left Side Right Side iddle Front Middle Rear S Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc 518-793-2290 Fax#518-793-2115 v_ 321 E-mail: momingstarseptic@hotmail.com www.morningstarseptic.com PTINC WORVIC■ Date: /© ' `� - "� 107 Jewel Road,Gansevoort,NY 12831 TO: V � & ��- 2,, M A P "I have seen of observed,or believe I save evidence of, all obiects Such as houses, 4,alls, trees, zances, etc., sh ::lr; : this docuriient. I also represent that I have 00 z 'Y t=4:asurcd vdistances set forth on the diagram." SIGWATURE DATE pL { PL � j