2009-130 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090130 Application Number. A20090130
Tax Map No: 523400-308-019-0001-042-000-0000
Permission is hereby granted to: RICHARD PASHBY
For property located at: 31 PINELLO 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: RICHARD PASHBY
31 PINELLO Rd Septic Alteration Residential
QUEENSBURY,NY 12804 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2009-130
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,April 20, 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 T,wn-of Queem7w, ry, / o Idly April 20, 2009
SIGNED BY n° ° , ' for the Town of Queensbury.
V
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
(zt Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Pen-nit Number. P20090130 Date Issued: Wednesday, April 22, 2009
This is to certify that work requested to be done as shown by Permit Number P20090130
has been completed.
Tax Map Number. 523400-308-019-0001-042-000-0000
Location: 31 PINELLO Rd
Owner. RICHARD PASHBY
Applicant: RICHARD PASHBY
This structure may be occupied as a:
Septic Alteration Residential
By Ogler of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the f% Y
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.
- r\
i
�- ,I�--� OFFICE USE ONLY �--------
R
SAX MAP N PERMIT NO.
//-514ERMIT FEE_
APPROVALS: ZONING ,
TOWN CLERK
--------------
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT.
--- II
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFOREyllT�
PERMIT.
ISSUANCE OF A VALID
OWNER: J
INSTALLER:oo� / L r (/
ADDRESS:
�U DDRESS:
?n
PHONE NOS.—W--,,— ` r i
PHONE NOS. �2
LOCATION OF INSTALLATION:
YEAR BUILT NO.OF
1980 or older
BEDROOMS X COM TOTAL DAILY FLOW
PUTATION= RESIDENCE INFORMATION:
=
X 150 gallon per bedroom _ GARBAGE GRINDER
1981 -1991 X 130 gallon per bedroom INSTALLED?—
1992-present X 110 gallon per bedroom - SPA OR HOT TUB
INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling K Steepslope_ o
pe /oSlope
✓ SOIL NATURE: Sand
Loam Clay_ Other
✓ GROUNDWATER: At what depth?— /
✓ BEDROCK/IMPERVIOUS MATERIAL:
At what depth?
✓ DOMESTIC WATER SUPLY: Municipal Well
(If well: Water supply from any septic
✓ system absorption is—__ft.)
inute per inch.
PERCOLATION—TEST: Rate is
(Test to be completed by a licensed professional engineer or architect.)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems m
a licensed professional engineer or architect (unless installed in a Planning Board approved subdivision).
must be designed by
TANK SIZE: J6 ,� � S ivision).
/ _GALLON (MI . SIZE IS 1,000 GAL.) Add 250 gallons to
each garbage grinder, spa or whirlpool tub. g the size of the septic tank for
SYSTEM TYPE:
ABSORPTION FIELD (WITH NO. 2 STONE) Total lengt Go ft 1
,1 . Each trench O'er X S 0
❑ SEEPAGE PIT(S) (WITH N0. 3 STONE ---
How many?—A�L Size?
❑ ALTERNATIVE SYSTEM
Bed or other type?
❑ HOLDING TANK SYSTEM Total required capa ity
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,
..............
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.
on
I have read the regulations with respect to this application and
agree to abide by these and all requirements of the Town of QUESTIONS? CALL 761-8256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance.
codes�aueensbur�^"
VISIT OUR WEBSITE FOR MORE INFORMATION
$I �llp ww►►w.queensburv.net
g re of Person Respons I Date
QTown of Queensbury - Community Development Office - 742 BayRoad,, Queensbury, NY 12804
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Rd., Queens ury, NY 12804 Inspector's Initials: 1�
NAME: �S '�. O P PERMIT NO.: �-'' I
LOCATION: - INSPECT ON: Nor
RECHECK:
Comments and/or diagram
Soil Ty an Loam/ Clay
Type of Water: Non7@pW Well Water
Waterline ration distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone-
Seepage Pits: Number "
Size:
Stone Size:
Piping Size Type
Building to tank `-C —
Tank to Distribution Box 10' C
Distribution Box to Field/ Pit A u -LO
Opening Sealed: Y N
End Ca Y . N
Inlet/Outlet Pipes&Baffles
Location Separations
Foundation to tank
Foundation to absorption - ft.
Separation of Pits ft.
Conforms as per Plot Plan Y_
Engineer Report and As-Built Y
Location of System on Property:
Front bar Left Side Right Side Middle Front Middle Rear
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
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