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2002-597 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 EATIFICil-ITE OF COMPLIANCE Permit Number: P20020597 Date Issued: Monday,July 22,2002 This is to certify that work requested to be done as shown by Permit Number P20020597 has been completed. Tax Map Number. 523400-308-015-0001-68-000-0000 Location: 3 PINELLO Rd Owner: , ARTHUR.ALMY Applicant: ARTHUR ALMY This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QuEENSBURY e ent Director of Building&Code Enforc TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 r- L E COPY Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020597 Application Number: A20020597 Tax Map No: 523400-308-015-0001-058-000-0000 Permission is hereby granted to: ARTHUR ALMY For property located at: 3 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. Tne of Construction Value Owner Address: ARTHURALMY Septic Alteration Residential 14 GIBSON Ave Total Value HUDSON FALLS,NY 12839 Contractor or Builder's Name Address Electrical Inspection Agency IBS SEPTIC NY 12904-0000 Plans&Specifications 2002-597 Septic alteration Lot 1 per plot plan specification comer Pinello Rd& Corinth Rd. $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,July 12,2003 (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 Town of Quep day Jul r-12,;002 SIGNED BY ;CZ,the Town of Queensbury. Director of Building&Code EnforVZ:nt�h Application for Permit—Septic Disposal System Town of Queetisbilly 7.12 Bay ffintd Queeitsbuly, (518).761-82-56 )_ I. OWNER INFORMATION: P, - I-P ........... ......................... .................................................................... office Use Location of installation: P"A"C' (,('0 od Pilo Ponuit No.F L Ma Ab-e viner's N Axle: Fee PaidC7/_1_D ............... ....................................................................................... Y Add A-Fd :!>09 , T-�l 2. INSTALLER'S NAME PHONE NO. 3. RESIDENCE INFORMATION:- (circle year of dwelling, indicate #bedroom(v) and multiply Il o ' V bedrooms with applicable gallons per bedroom to equal total dcfi1j,jloiv) Year of House: No. of Bedrooms x Computatiou = Total Daily Flowj 1980 or older x 150 gal/bdrju = 1980- 1991 x 130 gal/bdrin = P P_ C 1991 —present x I 10 gal/bdrin = J04 Garbage Grinder Installed yes / no 3� Spa or Whirlpool Installed yes no Op Q0 ZOO?Q�/V" Z_ 0 90 URA 4. PARCEL INFORMATION: (circle applicable information &indicate measurements) �4� a T 'ra )lly S Bed qt:lml;tq!:vi�Ltj;jl%4aL i.Ll Water st!,?,L 'r" - �eet --- ly R tit /it tit I pth !,"g" V" Let well Steep slope clay if well; water supply slope other fi11 any septic-systein delf1h: absorption is other Percolation Test: (7obe6oml,,Ietedbyliceii.yedpi-ojissiviialefigiiieerortii-ellifect) Rate: —Ininute per,inch 5. PROPOSED SYSTEM: For Neiv Constmeligat: All individual sewage disposal systems mus(bc designed by a licensed proressiolial engineer or architect(unless installed in Plaiiiihig 13oardapprowd subdivision). Add 250 gallotis to the size or oic septic lank and leach field for each Garbage Grinder,Spa or Whirlpool Tub. b-, S-V Septic Tank: gallon(nrin. size 1,000 gal.) Tile Field: each trench J1. Total System Leugdi: Seepage Pit(s): number If__J__ size of each: /,)_ fi. by Size of Stone to be used: ff depth or thickness C:7), Meet Bed System Size: x Alternative System length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: Size of each:_gallons 1 TOTAL Capacity: gallons Note. Alarm System and associated electrical work must be inspected by a Town approved electrical inspe6tiou 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 iu reliance upon any material inisrepreseutation or failure to make a material fact or circutus.tauce known by or on behalf of an applicaut, shall be void. I have read tiro regulations With rosi—t to this application and agree to abide by these and all requirements of the Town of Quecusbury Sanitary Sewage Disposal Ordinance. s ature of responsible erson Date � � va nx -n^rno7ira z :'3(D :1 Q: 10 Q N M N "0 a N `C N H ct 0 � N Q o 0 Q � c+ Oc+ to a C+ U M-h © M� Ilv 0 � � d 0 (D � 0a � � � (AtA i � 10< 0 -h m a : a '10 mm a -�QI (D a Ll m yp L Q r+ 0 ^s It 7 ct (+ N T m r (D (D ;9 OoOOO A 0 c+ 1 t .�, :r z a � (D0 (D co� �. Z(D M (D m ortC+ iot V ar s p IF1 I — ;� � o belie e 1-sa -evidc�►ce af, I t or obs rue , �s etc,, �e14 eS,_eaC, all bje fis uch as houe�; . � �ese�tth�t I aue is%u e t 1; i I_ -- oa he dia ram sh wn e es et ort 1 I e d��tan, 7,77TFIT' 1 1.1 ha« ll II v aver Aden e o c ve seen or otis�rved or-beli (ve-I� a et _ /� - use RP11s ree , fenc„l, sineh �s h ent tha I h ve —�fiow n", h-is do umenf. S alo r pre o th p� na1 rrieas lred the des antes s - - A"TUI;ETrqyN I�� 2Qp� -41 !� 1N AN D AY N.�?Yi� o ou— c1�tn shall 1 co plkltli Ge Y1�1� ��1�t@ _ �be tptlSlttl�� ' lire�� B'UfLDIN REVIEWED BY I I _ -17