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2001-863 TOWN OF QUEENSBURY 742 Bay Road, Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20010863 Date Issued: Wednesday, November 28, 2001 This is to certify that work requested to be done as shown by Permit Number P20010863 has been completed. Tax Map Number: 523400-309-009-0002-009-000-0000 Location: 109 LUZERNE Rd Owner: GABRIEL &PENNY PARUOLO Applicant: GABRIEL &PENNY PARUOLO This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TO OF QUE NSBURY e,D Director of Building& Code Enforcement TOWN OF QUEENSBURY s 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 f�� Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20010863 Application Number: A20010863 Tax Map No: 523400-309-009-0002-009-000-0000 Permission is hereby granted to: GABRIEL &PENNY PARUOLO For property located at: 109 LUZERNE 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: GABRIEL &PENNY PARUOLO Septic Alteration Residential 109 LUZERNE Rd Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/ Address Electrical Inspection Agency GABRIEL PARUOLO 109 LUZERNE Rd OUEENSBURY,NY 12804 Plans &Specifications 2001-863 SEPTIC ALTERATION AS PER APPLICATION $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Saturday,November 23,2002 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated a." +i e ' 'wn o' n u nsb ;/Friday,November 23,2001 SIGNED B r ' { for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit-Septic Disposal System Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256 1. OWNER INFORMATION: ------- -'' Office Use Location of installation: )6t ku1erne 2d, �-'®`' / 863 File Permit No. Tax Map No. /2-0/ 6 / Lei pp Fee Paid • /s Owner's Name: ( Jorie) ei' i7 T&ru.o/c Address: /05 Akzer-nt 2-d• ae rs6u-ri , iv` .. la-?dq 2. INSTALLER'S NAME : (a.v)riet 9rubio PHONE NO. 7% —//o 75' 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply# of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x Computation = Total Daily Flow itk` C$® 1980 or older c x 150 gal/bdrm = 3 00 /1/0 $‘40 1980—1991 x 130 gal/bdrm � r 1991 —present x 110 gal/bdrm = 14/4/GF OOy r a e Grinder Installed yes / no X- Ul`®1�G'��D 4/`��!/ Quee Garbage Spa or Whirlpool Installed yes_ / no )( G®pe Y 4. PARCEL INFORMATION: (circle applicable information &indicate measurements) 3:_opographv Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply lat saw at what depth at whgt depth unicipfl) Rolling loam 14/4-feet Pi feet well Steep slope clay if well;water supply %slope other from any septic-system depth: I absorption is ft. other Percolation Test: (To he completed by licensed professional engineer or architect) Rate: 1-C minute per inch 5. 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). Add 250 gallon to the size of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. Septic Tank: 1,000 gallon (min. size 1,000 gal) Tile Field: each trench 3 ft. Total System Length: 13 ft Seepage Pit(s): number of size of each: ft by ft Size of Stone to be used: # / depth or thickness feet Bed System Size: x Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency. 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read) 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 and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. VAdAtV ao-©/ Signatu a of responsible person Date TO WN OF QUEENSBURY Pi/ . BUILDING & CODE ENFORCEMENT SdilAt 742 Bay Road Queensbury NY 12804 eo-KI. c� (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name - 9� uL6 Location 09 > k/ Date `/ - / Permit # /40 SOIL TYP .:—S n5c3'am--Cl ay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: otal Length 1 ) Length of each trench • / Depth of trenches , , _3 Size of stone .\ — 147 SEEPAGE PITS: Numbe, - Size - ft. ft. Stone size .� PIPING: Size Type Bldg. to Tank c.— - `' N y' Tank to Dist. Box \ /t 4�3;" Dist, Box to Field/Pit ' Openings Sealed? _tt§___b No . Partial LOCATION/SEPARATI . - -. Foundation to Tank 'VX,t feet Foundation to Absorption . , srfeet . . Separation of Pits feet Conforms as per Plot Plan Y LOCATION OF SYSTEM ON PRO'ERTY: (circle one) _________-__1 Front - Rear - Left Si. - Right S Middle Front - Middle ; • - ----- COMMENTS: • SYSTEM.USE APPROVED: YE 0 Arrived- r' Depar ed: '' f'., uf1d1ng pector 11111 AW) TOWN OF QUEENSBURY . BUILDING. & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name O Location )- Date \\ c.�' ) Permit @DO 1- 3 SOIL TYPE- S am-Clay- Results of Percolati • Test- (if applicable) Rat .-- inute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length . �C-G Length of each trenc �. Depth of trenches 7 Size of stone . - SEEPAGE PITS: Number- i Size - ft. x I ft. Stone size j PIPING: ize Type Bldg. to Tank ` 41( t.4 Tank to Dist. Box Dist. Box to Field/Pit - « Openings Sealed? 00001 Ni Partial LOCATION/SEPARATI1 , Foundation to Tank a feet Foundation to Absorption +-feet Separation of Pits _ et Conforms as per Plot Plan Y s - 0 LOCATION OF SYSTEM ON PROPER ° . (circle one) . Front - Rear - Left Sid - Right Sid e Middle Front - Middle R COMMENTS: 'P S)ND \ P-SA‘). • v--vo • Gam \- C,0 SYSTEM USE APPROVED: YES O Arrived: Depar• -d: ;41-7eing I 'sp-ctor. /gfrao 47-0,44. TOWN OF QUEENSBURY . BUILDING & CODE ENFORCEMENT (Lef 742 Bay Road .)1,„1 jZ Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name r-i'74-4/ / ria%' Location /U 4j e' e / Date // /,4 Permit #_0 1 _ 23 SOIL TYPE: Sand-Loam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length Length of each trenc Depth of trenches Size of stone 111 SEEPAGE PITS: Number Size - ft. x 1 ft. Stone size PIPING: I Size Type Bldg. to Tank Tank to Dist. Box Dist. Box to Field/Pit Openings Sealed? Y: . No Partial LOCATION/SEPARATIONS: Foundation to T.nk feet Foundation to Absorption feet Separation of Pits feet Conforms as per Plot P an Yes No LOCATION OF SYSTEM ON 'ROPERTY: (circle one) Front - Rear - Left Si•e - Right Side Middle Front - Middl - Rear COMMENTS: vile^r Gier sr"- .."1,J4A SYSTEM USE APPROVED: YES 602) Arrived: l 1 yT Departed: Building Inspector CbrieI =� : iuoIo 109 Luz , . , . . . . . . N G ' QUEENSB Y G & CEDE PEPT. REVIEWED BY ►. . /! u w l�n e 4, 1. , , a . . .--.,-- 50 0 50 100 150 200 Feet N Streets.shp _ ,_ Buildings W � � E • Parcels • s