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2001-658 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20010658 Date Issued: Thursday, August 30, 2001 This is to certify that work requested to be done as shown by Permit Number P20010658 has been completed. Tax Map Number: 523400-308-019-0001-049-000-0000 Location: 60 PINELLO Rd Owner: BRIAN BENJAMIN Applicant: KEITH GILLIGAN This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Director of Building&Code Enforcement let TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20010658 Application Number: A20010658 Tax Map No: 523400-308-019-0001-049-000-0000 Permission is hereby granted to: KEITH GILLIGAN For property located at: 60 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: BRIAN BENJAMIN Septic Alteration Residential WANDA WELCH Total Value 60 PINELLO Rd QUEENSBURY,NY 12804 Contractor or Builder's Name/ Address Electrical Inspection Agency CONDONS SEPTIC &DRAIN SERVICE Plans &Specifications 2001-658 KEITH GILLIGAN SEPTIC ALTERATION AS PER APPLICATION $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Friday,August 30,2002 (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 Queensb ry; Thursday,August 30,2001 SIGNED BY for the Town of Queensbury. Director of Building ode forcement • . . . • , . ... . . , . . . Application for.Periiiit-, Sciiitic..D.i6.Disposal S.TOR:INE:Fe.:1::s c , ' .i c...0. . ,• . TOIPIl of Qttonsb.itry 742 Bay/load Queensltuty, NY)12804 (518) 761-8256V CZ li 1. OWNER INFORMATION: . • . . '..) . " '. - • . • AUG '... . ,./ o.40 • . - LOcation of instaHlation:k piwea .AD . , BurLphy, ,, ,NsBurece -(0 -Vito-1w- liCIECnDE / "-'401. • • • 'Foe Paid Ownor's Name:gerriii. • - 0.i, - , . - • . _ rwifA,,o. . . . Addresc-66 fixe/A /CD - _ . , . - - • . , . -2. .:.INSTALLER'S NAME :aiiida/US' S\P/D-fiC-'''`I-. 609:titiStr'S PHONE NO.7ierteir'crili - • . - - 3.• RESIDENCE INFORMATION: (circle year of dwelling, indicate II bedraom(s) and multiply II of • , • bedramhs with applicable gallons per bedroom to equal Iola!daily flow) . , . • Year of House: . No. of Bedrooms l' lc 'Comp1444km -- ' Total Daily Flow . ' . - . 1980 or oldor .. , . - . - '•x : -650 gol/bdrin 1980- 1991 . . . • ' x ' 130 gandrin , . 1991 -present. - ' . -.' x 110 gallbdrin .= . . , . . . . . . .. , Garbage Grinder installed : yes - . / . • , . , . Spa or Whirlpool Installed yes -I gr.. . , • .. i . . . . . 11. PARCEL INFORMATION: (circle applicable information & indicate measurements) - • . • .4 . UMW :...5.Q. Ilk.t11.0....._ .ci.tUtiltd.W.nt.er_. i_119sIkockoriiiiperyiousiy_tiderial_ _Domestic 4 fitor.Supply - . • " gel '- - aiii IP at.u-igt2hyan .-. ari, t(h.rn .• -4/iiitafff° oiling • . . am , .jeet - #_feet Steep slope -clay . if well; wafer supply . %slope other. • - • from any septic-system •" , . . depth: - , - - - ' . ., . . - absorption is - ft. . . -other Percolation Test: (To be completed by lice*ed Professional engineer or architect) . . , : r Rate' iv 0 - ..-:tillnitte periods , . . , . . . . • , . . 5., - PROPOSED SYSTEM: for New Constructlen: .All Individual sewngedisposal systems must be.dcsigned by h licensed . . . . . professional.engineer.or architect (unless installed in•a Planning Board approved snbdivision) Add 5() gallons to the size of the septic lank and leach field fur each Garbage(kinder, Spa or Whillpool Tub. . • „ . h . - tOcr'e4iL 119/1/K1 C4I/Ci • Re ri4V-, Mei( Ya. ys : '. . . . Septic Tank:. IP-'. -gallon Orlin. size 1,00G gal). . . . .. '-. Tile Field; each trench ',II. Totiii System Length:"---------', - -ft -. • , . . • • Seepage Plt(s): number of - ( ,.. .- .size (leach:• -----7r, by -.11. • . . . . . : . • ,---_—..--- - • . - • Size of Stone to be mod: • // -----;---__ / iteptli or thickness_ ___ _li?et . . ' • ., : 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 inspection agency. , .. '. . • 7..; SIGNATURE_&INFORMATION_FOR RESPONSIBLE PERSON (please read) • .. . - For your protection. please noteitlint Pursuant to Section 136-29 of the Code of the Town , ' . . •- of Queensbo-ry, any permit or approynl granted which is based upon or is granted in roliancoopon-any material misrepresentatiou or failure to make-a material fact or '. . -. - circumstance known by or on belinlf.of nit applicant, shall be void. •. I have road the regulations with respect to this nppliention and agree to abide by those and all : . requirements of the Town of•Queensbury Sanitary SoWago Disposal Ordinance. ,. . • • Ofr" TuP -..Qy\_#,Gh- - . . . . g-. -.D-7 © Signature of responsible person . . Date . , • . . _ , . . . \-i3b TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name /1,' ll� Location a7) 1 l�P/1 d 1411 Dates- 04,1,46 Permit #0 I -6,52 SOIL TIP!: Sand-;Loam-Clay- Results o ', colatio Te t- (if applicable) Rate- ,inut: Inch TYPE OF SYSTEM: ABSORPTION FIELD: ipta Length Length of each tre "ch Depth of trenches Size of stone MIMI" SEEPAGE PITS: Numbe7lOW Size - ft. x ft. Stone size PIPING: �;size Ty k Bldg. to Tank ✓1 � Tank to Dist. Box .4 " Dist. Box to Field/Pit Openings Sealed? Yes No Partial LOCATION/SEPARATIONS: ' Foundation to Tank feet Foundation to Absorption . feet Separation of Pits eet Conforms as per Plot P1 an Ye No LOCATION OF SYSTEM ON PROPERT •• (circle on- Front - Rear - Left Side - Right Side Middle ' : t - Middle Rear COMMENTS: • ::s APPROVED: Y NO / Departed: i - / J .---\1Y - Building Inspector i ry o ?0-,00 ,L sv 7 - ir4 Ni Iv o3 O Tv 0/./3,v1 d 09 N coQ s. , r. 1 S1 �3 , 1 "I have seen or observed, or believe I saw evidence of, b�� "- all objects such as houses, wells, trees, fences, etc., 't 31) ' 1,01 S DD II' shown on this document. I also represent that I have i r) ' — 14 a personally measured the distances set forth on the diagram." 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