2010-387 TOWN OFQ UEENSBURY
wom 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20100387 Date Issued: Tuesday, August 17, 2010
This is to certify that work requested to be done as shown by Permit Number P20100387
has been completed.
Tax Map Number. 523400-295-019-0001-041-000-0000
Location: 15 PINEWOOD Ave
Owner. STEPHEN & LINDA BARSON
Applicant STEPHEN & LINDA BARSON
This structure may be occupied as a:
4
Septic Alteration Residential
4,
By Order of Town Board
TOWN F QUEE SB !'Y
Issuance of this Certificate of Compliance DOES NOT relieve the ;ws 1
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.
TOWN OF QUEENSBURY
AOS 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100387 Application Number. A20100387
Tax Map No: 523400-295-019-0001-041-000-0000
Permission is hereby granted to: STEPHEN & LINDA BARSON
For property located at: 15 PINEWOOD Ave
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: STEPHEN & LINDA BARSON
15 PINEWOOD Ave Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC &DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
QUEENSBURY,NY 12804
Plans &Specifications
2010-387
septic alteration
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,August 05, 2011
(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.)
/ j f2
Dated at the To o eens , S`dCay,August 05, 2010
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
_ OFFICE USE ONLY
'�
TAX MAP NO.�� 4/ PERMIT NO.� c / PER FEE
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER: 5T6(/(' �/Sa INSTALLER: 2
ADDRESS: / `1A ( ( b o J (,( vC ADDRESS: CD 1v[�` [„-�t/"e.'s-'J I
PHONE NOS. PHONE NOS. ?/ .r g1,P y
LOCATION OF INSTALLATION: 7/7S1 f/L- e (� _op CA- S
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDER,
1980 or older 3 X 150 gallon per bedroom = ' d • INSTALLED?
1981 -1991 X 130 gallon per bedroom = V SPA OR HOT T
1992-present X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION: `` ��/
✓ TOPOGRAPHY: Flat rolling/ Steep sloped/ %Slope�l/A
✓ SOIL NATURE: Sand Loan/A_ Clay /t/ Other/M.4
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?1/74
✓ DOMESTIC WATER SUPLY: Municipal cr Well_ / (If well: Water supply from y septic
system absorption is /� ft.)
✓ PERCOLATION TEST: Rate is /1/4minutes per inch [MPI]
(Test to be completed by a licensed professional engineer or architect.)
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).
TANK SIZE: 10�o 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 TYPE:
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length/t /ft. Each trench /'A X .(/74
O SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? z(/i`i Size? ,04
ALTERNATIVE SYSTEM Bed or other type? f ( 2) �y
O HOLDING TANK SYSTEM Total required capacity? /f7(
Tank size? AAA Number of tanks?/(A
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.
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17
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Septic Inspection Report
Office No. (518) 761-8256 Date I nest received:
Queensbury Building&Code Enforcement Arrive '] am/p p r :- am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector' Initials:
NAME: w PERMIT NO.: /0 0 PF
-
LOCATION: < INSPECT ON: g-•/2 r
� 71'i2i��I /o
RECHECK:
Comments and/or diagram
Soil Type: oam/Clay
Type of Water: unici..1/Well Water
Waterli e sepa ;tion distance ft.
We - • ration distance ft.
Other wells: ft.
Well Casing Length 50'+/ - Y N N/A
[150'to well required if NO]
Absorption Field: Total length 7 " t I
Length of each trench
Depth of trenches ft.
Size of Stone i
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit 460 20
Opening Sealed: N
End Cap _,_N
Inlet/Outlet Pipes&Baffles Y N
Manholes 12"or less below grade _Y N
[provide extension collar if Yes] Y N
Location/ Separations
Foundation to tank ft.
Foundation to absorptionft.
Separation of Pits ft. // //1
Conforms as per Plot Plan t Y—N 4,g /T % U �L 1
Engineer Report and As-Built _,_,•Y N
ETU Maintenance Contract _Y_ N
provided
Location of Syste r •• •re!looperty:
Front Left Side Right Side Middle Front Middle Rear
stem Use Statu .
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: 0 (i ///(`
Queensbury Building &Code Enforcement Arrive: am/pm Depart: /L= =1 , am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: (3 ` `
NAME: V—' CM PERMIT NO�:/) 0 - 3 ' 7
LOCATION: i �� ,.e w6(.4) 1flVl- INSPECT ON: I
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Municipal/ Well Water
Waterline separation distance ft. a/lx5 -\, <f
Well separation distance ft.
Other wells: ft. ✓�rysT� �„ ')5 eito
Well Casing Length 50' +/ - Y N N/A
Absorption Field: Total length ft. f 7----1-6(-'6.--AA/45Length of each trench ' ft.
Depth of trenches .G-1-- ft.
Size of Stone
See. .'e Pits: Number
Size: x
�zr' a
Stone Size: .-----
Piping Size Type
Building to tank --/+�fy� —
Tank to Distribution Box �9 t
Distribution Box to Field/ Pit t ��-.C�w v
Opening Sealed: �jF
End Cap ✓Y_N
Inlet/Outlet Pipes&Baffles ^.Y,®NMAA-ia
Location/ Separations
• Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan _.Y, N
Engineer Report and As-Built —Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
- • .
Approved
V 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
71/ f r
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., Queenbury, NY 12804 Inspector's Initials: j / ` J,(4G-Y
NAME: f25)-(SC)fr-21' PERIT NO.: ✓U •
LOCAION: /6 ; t,.5 INSPECT ON: — Ar.- f a
RECHECK:
Comments and/or diagram
Soil T •-• .n• / Loam/Clay
Type of Water Mu -1.- /Well Water
Water me separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' +/ - Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft.
Length of each trench ft. (--°1/'"(T-4)1•-•
. 4)
Depth of trenches ft. �---�
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size T
Building to tank er <'
Tank to Distribution Box 0`
Distribution Box to Field/ Pit `^'
Opening Sealed: N
End CapN
Inlet/Outlet Pipes&Baffles IfY N tett f V"u< -
Manholes 12"or less below grade Y_N c,,�.�pp
[provide extension collar if Yes] Y N �'- .i7�
Location/ Separations -ctA � ,flJ}J(.
Foundation to tank ft. CJu ._
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan _Y—N
Engineer Report and As-Built Y N
ETU Maintenance Contract _Y N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
stem Use ILL, s:
Approved
A/ Partial Approved and needs to be re-inspected, please call the Building &Codes Office
SW Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forrns\Septic Inspection Report..03 29 10.doc
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Septic Inspection Report
Office No. (518) 761-8256 Date In - o request received:
Queensbury Building&Code Enforcement Arrive: „,._!..., : am/ , pePtrt: am/pm
742 Bay Rd., Queensbury, NY 12804 Ins.- • Initials: I_
NAME: (-) _ PERMIT NO.:
LOCATION: /5 -JR PA , pool AVS INSPECT ON: . 4111M0
RECHECK:
Comments and/or diagram
Soil Ty. / Loam/Clay
Type of Water: - •t / Well WaterY.--tri
Waterlin; .;ration distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+/ - Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft.
Length of each trench ft. /�o� �N S�A LrD
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Siz Ty
Building to tank / ” �Q C�
Tank to Distribution Box ‘-'p 5�`
Distribution Box to Field/ Pit
Opening Sealed: ✓Y Ilif
End Cap Y
Inlet/Outlet Pipes&Baffles Y_N 6)(f} -pv,ik j!}- FL&S
Manholes 12"or less below grade _Y—N
[provide extension collar if Yes] Y—N
Location/ Separations
Foundation to tank !U ft.
Foundation to absorption ft. Q44 1-
0 (oveR L,/a �z l4-- \4" k 1
Separation of Pits 1 ft. _ - v
Conforms as per Plot Plan ✓ Y—N
Engineer Report and As-Built Y N
ETU Maintenance Contract _Y N
provided party.
Location of System on Pro C"It, c' e&,,,,K
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
pproved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection ReporL03 29 10.doc
��` TOWN OF QUEENSBURY
`O 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
N
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100387 Application Number. A20100387
Tax Map No: 523400-295-019-0001-041-000-0000
Permission is hereby granted to: STEPHEN&LINDA BARSON
For property located at: 15 PINEWOOD Ave
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: STEPHEN & LINDA BARSON
15 PINEWOOD Ave Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builders Name/Address Electrical Inspection Agency
IBS SEPTIC &DRAIN
ATTN: WAN BELL
2 LOWER WARREN St
QUEENSBURY,NY 12804
Plans &Specifications
2010-387
septic alteration
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,August 05,2011
(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 To -t>fQueens9 ry sday,August 05,2010
SIGNED BY \\\ y %1
for the Town of Queensbury.
Director of Building&Code Enforcement
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