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2002-124 J� TOWN OF OUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761.8256 CERTIFICATE OF COMPLIANCE Permit Number.. P20020124 Date Issued: Friday,March 01,2002 This is to certify that work requested to be done as shown by Permit Number P20020124 has been completed. Tax Map Number: 523400.295-017-0001-045-000-0000 Location: 11 PINEWOOD HOLLOW Rd Owner: MICHAEL&KA.THLEEN CIRELLI Applicant: MICHAEL&KATHLEEN CIRELLI This structure may be occupied as a: By.Otder of Town Boatd Septic Alteration Residential 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$256, BUILDING PERMIT Permit Number: P20020124 Apphcation,Nuxnber: A20020124 Tax Map No: 523400-295-017=0001-045-000-0000 Permission is hereby granted to: . MICHAEL&KATHLEEN CIRELLI For property located at: 11 PINEWOOD HOLLOW Rd in the Town of,Queensbury, to construct or place at the above locatian;in accordance with application together with plot plans and other information Hereto filed and,approved and in;compliance with the NY S Uniform Building Codes and the Queensbury Zoning Ordinance. Type of Construction Value Owner Address: MICHAEL&KATHLEEN CIRELLI Septic Alteration Residential 11 PINEWOOD HOLLOW Rd Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name j Address Electrical Inspection Agency CONDON SEPTIC,&DRAIN SERVICE I f , s Plans &Specification's 2002-124 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE,PAID - THIS PERMIT EXPIRES: Thursday,February 27,2003- _ (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 own a Que b e esday,February 27,,2002. SIGNED BY 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 f,i 4 File Permit Now a Tax Map No. 0 s ' 1�/1Cl �Il i Fee Paid. Owner shame: Address: ' AMEC`C%'n� �/d,�r C /G(J f �fl/C" PHONE NO. 2. INSTALLER S,N s•�" S 3. RESIDENCE INFORMATION: (circle year of dwelling,indicate 9 bedroom(s)and multiply# of bedrooms v&h-applicable gallons per bedroom to equal total daily flow) Year of House' No of Bedrooms x Computation = Total-Daily Flow f 1980 or older x 150 gal/bdim 1980—"1991 ��— x 130-gal/bdrm = 1991—present', x 110 gaUbdrm = _ RECEIVED Garbage Grinder Installed yes— / no FEB 2 2 2002 Spa or Whirlpool Installed yes._ / no TOWN OF QUEENSBURY 4. PARCEL INFORMATION: (circle applicable information&indicate measurej&WO NG AND COME T o h ; S it N re Ground Water Bedrock or ervious Material - Domestic Water Su 1 at at what depth at what depth munici al Rolling? oam ��_feet" �/ Jeet well Steep slope clay ifwell,water supply °/a slope other - from any septic system depth: absorption is other Percolation Test: (To be completed by licensed professional engineer or architect) Rate:: 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 gallons to the size of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub. Septic Tank:1�gallon(min.size 1;000 gal.) Tile Field: each trench }t Total System Length: 4A00 t Seepage,Pit(s):' number of size of each: fr by, Size of Stone to:be used: # / depth or thickness feet Bed System Size: x . temr� Y� S length and/or size Alternative Sys 6. HOLDING TANK SYSTEM: (if required) Number oftanks: / Size of each: gallons f 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 ofthe Town of Queensbury Sanitary Sewage Disposal Ordinance. 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M 0 Q;-r.W -r- +j H r-r (0 r (10 0 0 03 0 0 U Sr 'r Q � 0 id Pi zf—Ct 1 j TOWN OF-QUE-F.NS13UA Sauk BUIL DIN(a & REVIEWED BY DATE S �, �7 0 -z c �� z r n O Cp �. o o "l .have seen or observed, o�.believe l!li trews fe evidence etce of, all objects such as houses, ' shown on this document. I also represent that I have10 -,,, personally measured the distances set forth on the diagram. --DATE SIGNATURE