2012-143 `aTOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120143 Date Issued: Tuesday, April 17, 2012
"~ This is to certify that work requested to be done as shown by Permit Number P20120143
has been completed.
Tax Map Number: 523400-301-018-0001-044-000-0000
Location: FAWN LANE, OFF
Owner: SHERMAN PINES HOMEOWNERS ASSOC
Applicant: SHERMAN PINES HOMEOWNERS ASSOC
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the (-344001
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 ^rce t
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
14,0742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120143 Application Number: A20120143
Tax Map No: 523400-301-018-0001-044-000-0000
Permission is hereby granted to: SHERMAN PINES HOMEOWNERS ASSOC
For property located at: FAWN LANE, OFF
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: SHERMAN PINES HOMEOWNERS
C/O MAXWELL PROPERTY MGMT Septic Alteration Residential
PO BOX 332 total varve
SARATOGA SPRINGS,NY 12866-0
Contractor or Builder's Name/Address Electrical Inspection Agency
STONE INSTALLATIONS
4305 ROUTE 50
SARATOGA SPRINGS,NY 12866-0000
Plans&Specifications
2012-143
Septic Alteration for 19 Peachtree Lane, 2 Fawn Lane & 10 Fawn Lane
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, April 03, 2013
(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 nsbufet Tu a April 03,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
- Community Development Office
- • Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only �^ q� f
TAX MAP NO. W i•r3/-2H PERMIT NO. la—14/3 PERMIT 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: SHERMAN PINES HOMEOWNERS ASSOCIATION INSTALLER. STONE INSTALLATIONS
ADDRESS. P.O. BOX 332, SARATOGA SPRINGS, 12866 ADDRESS
PHONE NOS (518) 331-9369 (JOHN SAFFORD) PHONE NOS 232-6707 (DEAN BURDICK)
LOCATION OF INSTALLATION: 19 PEACHTREE LANE, 2 FAWN LANE, 10 FAWN LANE (COMBINED SYSTEM)
RESIDENCE INFORMATION:
YEAR BUILT NO.OF COMPUTATION
X =
BEDROOMS (Gallons per bedroom) TOTAL DAILY FLOW
GARBAGE GRINDER
1980 or older X I 150 = INSTALLED?
1981 -1991 X 130 = I SPA OR HOT TUB
1992-present X 110 = I INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
✓ 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)
✓ PERCOLATION TEST RATE IS 1 MIN 25 SEC PER MIINUTE PER INCH[mpg (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: 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 ft Each trench X
❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size?
2(ALTERNATIVE SYSTEM Bed or other type? ABSORPTION BED PER ORIGINAL SUBDIVISION PLANS
❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
(1) 25'x55' ABSORPTION BED
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 matenal 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 requir the Town of Queensbury QUESTIONS 7 CALL 761-8256 OR EMAIL
Sanit Sewaiig) Disp6$al0 ance. codesCa)aueensburv.net
/MA.A 4/2/12
Sig tune of Person Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/ m Depart: • am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: AJ
NAME: ¶'N PERMIT NO.: 20 (
LOCATION: fl t <-4.da- f - INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Municipal/ Well Water
Waterline 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.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number caice-0\it )
Size:
Stone Size: / `
Piping Size Type
1.
Building to tank N
Tank to Distribution Box AC—) 112)4-71Aar
Distribution Box to Field/ Pit
Opening Sealed: _Y_N
End Cap Y 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 absorption ft.
Separation of Pits ft
Conforms as per Plot Plan Y k
Engineer Report and As-Built Y N
ETU Maintenance Contract _ _N
provided
Location of System on Property:
Front • :.r Left Side Right Side Middle Front Middle Rear
S stem StaA _
Approv=:
•: •.1 Approved and needs to be re-Inspected, please call the Building &Codes Office
Disapproved
Lt\Pam Whiling\2010\Building Codes FormAInspection Foma\Septic Inspection Report_03 2910.doc
— i a -i�r'3
169 Haviland Road
Queensbury, NY 12804
Hutchins Engineering Phone: (518)745-0307
9 g Fax: (518)745-0308
April 12, 2012 n _ra Q 1 nn
Town of Queensbury Building Department U
742 Bay Road APR 13 2012 L
Queensbury, NY 12804
TOWN OF QUEENSBURY
Re: Sherman Pines Subdivision BUILDING &_CODES
19 Peachtree Lane, 2 Fawn Lane, 10 Fawn Lane
Our office has inspected the installation of the replacement absorption field for the above-
referenced properties.
The replacement system consists of an absorption bed that is 25' wide by 50' long. The system
serves the three residences at the above-referenced addresses. Additionally, an effluent filter
was installed in a 4'x4'x4' precast concrete structure immediately prior to the absorption bed. A
polyethylene riser to grade was installed on the filter structure.
It is my opinion that the system was installed in general conformance with the original plans of
the subdivision. The effluent filter represents a significant improvement to the overall system.
Attached is a mark-up sketch showing record dimensions as located by the installing contractor.
Please contact me if you have any questions or if you require additional information.
Best Regards,
G. Thomas Hutchins, P.E.
Cc: John Safford, Sherman Pines Homeowners Association
G Thomas Hutchins,P E.
•
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/p • ..-.artie am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: t
_aa `
NAME: S_�/9 Pn PERMIT NO.: /a-Ps/8
LOCATION: e__
INSPECT ON: y-//-/a
RECHECK:
Comments and/or diagram
Soil Type: -y�r: Loam/ Clay
Type of Water: rti,us!I/ Well Water
Waterline separation distance ft.
Well separation distance L 'J� ft,
Other wells: _ft.
Well Casing Length 50' +/ - Y N N/A
Absorption Field: Total length ft.
Length of each trench b,S ft.
Depth of trenches ft. — � ��
Size of Stone 2
Seepage Pits: Number
Size:
Stone Size:
Piping Size Type
Building to tank _ _WASXT- t(o_lcad -c
Tank to Distribution Boxa Eda,4-o
Distribution Box to Field/ Pit " cq >%4 1 ( Y7as
Opening Sealed: N
End Cap N
Inlet/Outlet Pipes &Baffles VY N
Location/ Separations
• Foundation to tank _M." 0-'St CSnj 1-‘4*--*._
Foundation to absorption "Zap- ft.
Separation of Pits A ) &ft.
Conforms as per Plot Plan $
Engineer Report and As-Built Y d N ---2_ 12r2..C'r/L-b4� £-JC,-A51 QE:P -
Location of System on Property:
Front Rear Left Side Right i e Middle Front Middle Rear
Approved
Partial Approved and needs to b# ed please call the Building &Codes Office
Disapproved
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