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SEP-0189-2018 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-0189-2018 Date Issued: Wednesday, April 25, 2018 This is to certify that work requested to be done as shown by Permit Number SEP-0189-2018 has been completed. Tax Map Number: 295.17-1-44 Location: 13 PINEWOOD HOLLOW RD Owner: John Van Hatten Applicant: IBS Septic This structure may be occupied as a: Residential Septic Alteration By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the A , property owner of the responsibility for compliance with Site Plan 1. 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-0189-2018 Tax Map No: 295.17-1-44 Permission is hereby granted to: IBS Septic For property located at: 13 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: John Van Hatten Septic Disposal-Residential $0.00 Owner Address: 13 PINEWOOD HOLLOW RD Total Value $0.00 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 $ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday,April 23, 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 of y►.= ; "s` and 'A r i123 2018 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement Community Development Office " :: Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 Office Use Only P- 616c1•2Q(8 ' .ao I Ylvo i LL, ©'312— . TAX MAP NO. PERMIT NO. PERMIT FEE APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. A APPL CATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: Li O`^^ "CJtfN °( 'Ot `� INSTALLER: It J 3-e -1.-] c 4 0(mi, (1 ADDRESS: "4::: . \r-- P 1 C V U (11 0.1i ,VW ADDRESS::� � C r &sfo-i-..QbyPHONE NOS. S I. JO'OY 5 ' Ur� � -�ON�NO . LOCATION OF INSTALLATION: #-V� t i^-Q. `l. 0� , 9 OW RESIDENCE INFORMATION: NO.OF COMPUTATION YEAR BUILT X = TOTAL DAILY FLOW BROOMS (Gallons per bedroom) GARBAGE GRINR 1980 or older X 150 =• INSTALLED? 1981 -1991 X 130 = SPA OR HOT TN 1992-present J X 110 = ..1)`J INSTALLED? 1' PARCEL INFORMATION: 0 E',_.p E 0 Vfit — / TOPOGRAPHY: FLAT ROLLI G STEEP SLOPE %SLOPE / SOIL NATURE: SAND �pLOAM CLAY II OTf� 2 3 2O18 ✓ GROUNDWATER: AT WHAT DEPTH? I y is, 1'1 __ Il T O`d)N OF QUEENSBURY / BEDROCK/IMPERVIOUS MATERIAL: AT WH DEPTH? V ��ll3�3D mS ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ) ✓ PERCOLATION TEST: RATE IS \J PER MIINUTE PER INCH[mpi] (Test to be completed by a licensed professional engineer or architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: All ir:�:Jidual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). TANK SIZE: 13011) 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 T PE: 1f < i ['ABSORPTION FIELD(WITH NO.2 STONE) Total length t� ft. Each trench X U O /' ❑ SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size? o 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 circumstance known by or on behalf of an applicant,shall be void. I have read the eg a ins wi r respect to this application and agree to n; abide by the:- a . equi -ments of the Town of Queensb ry QUESTIONS? CALL 761-8256 OR EMAIL"=` Sanitary S- a;- ►," ros. Ordinance. ' r 1-n y( codes(cr�queensburv.net "[` �) l VISIT OUR WEBSITE FOR MORE INFORMATION Signal: f rs 1 Responsible Date www.oueensburv.net Pipeline Specialists JOB: TEAM SHEET 295.17-1-44 SEP-0189-2018 NO.: • Van Hatten, John 4 CALCULATED 13 Pinewood Hollow Road BY: Residential Septic Everett J.Prescott,Inc. � p � Alteration SCALE: N. a i ' i/E i t �,i i — r ! i 3 , , Y 4 i { i _ i. 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