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2015-412 gami TOWN OF QUEENSBURY coiiro 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20150412 Date Issued: Thursday, September 10, 2015 This is to certify that work requested to be done as shown by Permit Number P20150412 has been completed. Tax Map Number: 523400-302-005-0001-084-000-0000 Location: 23 OLD AVIATION Rd Owner: ANDREW PLISCOFSKY Applicant: ANDREW PLISCOFSKY 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 /Otproperty owner of the responsibility for compliance with Site Plan, �d 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 FON Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20150412 Application Number: A20150412 Tax Map No: 523400-302-005-0001-084-000-0000 Permission is hereby granted to: ANDREW PLISCOFSKY For property located at: 23 OLD AVIATION 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: ANDREW PLISCOFSKY Septic Alteration Residential PENNY MOORE Total Value 230 THUNDERBIRD Dr Suite J EL PASO TX 79912-0000 Contractor or Builder's Name /Address Electrical Inspection Agency IBS SEPTIC & DRAIN ATTN: IVAN BELL 2 LOWER WARREN St OUEENSBURY,NY 12804 Plans&Specifications 2015-412 Replacing tank only Current tank is under the deck and will be filled in $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, September 09,2016 (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 expiration date.) Dated at the T. -no ueens`;Ty; •d i esday, September 09,2015 SIGNED BY sa e � for the Town of Queensbury. Director of Building Code°'nforcement . E GENE Commun=ity Develgiornent 3v SEP 08 2015 Town of Qu: ensbury ° X42 Bay Road = Queensbury, New York -128i' TOWN BBUILD G &CODE-RY Office Use Only (3,_.,,, __e TAX MAP NO. PERMIT NO.?•c\`-5"L\t 2" PERMIT FEE/10 kli/ APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEF,L,RE ISSUANCE OF A VALID PERMIT. ER 't'r E, AI 4,C Or f. INSTALLER: ,) L) – t I (-- OWNER: OWN (� 1 /�� �j ADDRESS: D—) Q td 1 \I l(4tl01 1 vtt ADDRSS: /LO�/v VV tzt PHONE NOS_Cl.C c`Sy'1 / (")1 PHONE NOS. I �1 1 �S. 419'k LOCATION OF INSTALLATION: Z3 01 d 14 V i�C '1()ri N.(/k RESIDENCE INFORMATION: NO.OF COMPUTATION TOTAL DAILY FLOW YEAR BUILT BEDROOMS X (Gallons per bedroom) = GARBAGE GRINDER 1980 or older I -) X 150 = Lf-Q ') INSTALLED? I 11 1981 -1991 I X 130 = SPA OR HOTS 1992-present I X 110 = INSTALLED?ikied VA_ PARGEL INFORMATION: I TOPOGRAPHY: FLAT ROLLI STEEP SLOPE a %SLOPE ,Un C I ,p I ✓ SOIL NATURE: SAND LOAM 1V-PI" CLAY \V1V�I 1 OTHER V A, ✓ GROUNDWATER: AT WHAT DEPTH?_iv v ',____ ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? IV I 1/ 1 ✓ DOMESTIC WATER SUPLY: MUNICIPAL L./ WELL4 f well:water supply from any septic system absorption is: (V A.ft) I PERCOLATION TEST: RATE IS 11J + PER MIINUTE PER INCH[mpg (Test to be completed by a licensed professional 1100. 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: I COO ta1 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: _r Ni �} CI FIELD(WITH NO.2 STONE) Total length {v ft Each trench fV X IV I, o SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size? 1 r ❑ALTERNATIVE SYSTEM Bed or other type? / ❑ HOLDING TANK SYSTEM Total required capacity? : ,V 14- Tank size? V Py. Number of tanks? Id> 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 and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL Sanitary Se Dispos�i Ordinance. ' codesna cueansvu,v. e I9--s,(4, VISIT OUR WEBSITE FOR MORE INFORMATION Signator o e o lit Qonsible Date \` www.aueensburv.net -,\. 1 1 . . _' 1 4 I HI . __I__. I ___H_, 11.1 I li_ ._ 1 a iLf.--.. .. I .,* . :1 't, -.).! 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L___ ,. , 11111111N1111111111111111111111111.11111 Afill1111111111 11111 a 1101111111111111 1111111111111ESTMOINIKEEN.111 _Jill , 111111111111111,1111111111111111111111111Eri .011111111111111M111 Ell 111111111101111111111111111111111111111111111111N 11110111111111 -UN . 111 111111111111111111111111=111M 111111111M111111 BM . h1UU Town of Queensbury Building & Code Enforcement 8 -tO Office'No. (518) 761-8256 Septic Inspection Report Inspection request received: I9rte Name: 1\400.4U Inspected on: 91 I o 1 ZC S Location: 1273 /I�."b3 C)id C �®1'1 Arrive: . — rfp.n.L.) Permit No.: 2-C \ 5 ' 12— Inspector's Initials: WA Co ''ants and/or dia•ram Soil Tam I Clay Type of V atert-bfamci al II Water Waterline separation-distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50'+/- Y N N/A [150'to well required if NO] Absorption Field: Total length ft. � � ��� � Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank 1..'1 11 1ki Lkb Tank to Distribution Box A` .t3Z7(2-3 E _TO E `M j\\t L b Distribution Box to Field/Pit Opening Sealed: Y N End Cap Y/ N Inlet/Outlet Pipes&Baffles tel N Manholes 12"or less below grade �f' N [provide extension collar if Yes] Location/Separations Foundation to tank ‘® ft. AS But LT Foundation to absorption Separation of Pits10 ft. Conforms as per Plot P.e Engineer Repo and As-Bui Y N ETU Maintenance Contract provided Y N Location of S stem on Prose : Front Rear -ft Side Right Side Middle Front Middle Rear S stem Use Statu : Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Septic Inspection Report I 76 E iM a P '--- . ---.2. C-- C i4 0 Ca Li 4-2 N©1s J. I i. l_.__i___- i --_I- i —�—! 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