2012-491 TOWN OF QUEENSBURY
ET
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120491 Date Issued: Thursday, February 06, 2014
This is to certify that work requested to be done as shown by Permit Number P20120491
has been completed.
Tax Map Number: 523400-301-017-0003-034-000-0000
Location: PEACHTREE LANE, OFF
Owner: SHERMAN PINES I-IOMEOWNERS 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 / 41
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
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120491 Application Number: A20120491
Tax Map No: 523400-301-017-0003-034-000-0000
Permission is hereby granted to: SHERMAN PINES HOMEOWNERS ASSOC
For property located at: PEACHTREE 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
Septic Alteration Residential
C/O MAXWELL PROPERTY MGMI
MILTON TOWN CENTER Total Value
409 GEYSER Rd
BALLSTON SPA NY 12020-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
STONE INSTALLATIONS
NY 12804-0000
Plans&Specifications
2012-491
Septic Alterations Residential
8 Peachtree, 15 Autumn& 19 Autumn Lane
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,October 10,2013
(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 Town of Queensbury; Wednesday, October 10,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
k:. Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York .12804
OCT 0 5 2012
Office Use OnlyPU
/l
TAX MAP NO.\_301•t 3 -3'V
PERMIT NO. /4)-4-0/ PERMIT FEE V 00
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: 8 PEACHTREE LANE, 15 AUTUMN LANE, 19 AUTUMN LANE (COMBINED SYSTEM)
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = INSTALLED?
1981 -1991 X 130 = SPA OR HOT TUB
1992-present X 110 = 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 I WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS < 1:00 PER MIINUTE 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: 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?
c'ALTERNATIVE SYSTEM Bed or other type? ABSORPTION BED PER ORIGINAL SUBDIVISION PLANS
0 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 material fact or
circumstance known by or on behalf of an applicant,shall be void.
I hay- read the regulation- ith respect to this application and agree to
abi., by thes- an.-I re.�rements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sa te- S: :ge I •�'- r dieance. codes@queensburv.net
� 1 10/5/12
ign." re • Person Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
PJA(7,e;-).)T
ST 11\-)s ;y3cc617 67o7
Septic Inspection Report
Office No. (518) 761-8256 Date Ins!- ion r-.. r-t
Queensbury Building &Code Enforcement Arrive: 4'1 'r. r,A `'-•.rt: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: ,
NAME: ,&, C` s -\-�i 1 P�rr.NO.: / --(17 /
LOCATION: dr 2c1i - -{-re e 1 ea/IF. SPECT ON: 7— —Co— 19
RECHECK:
Comments and/or diagram
Soil Type: Sand / Loam/ Clay
Type of Water: Municipal / Well Water
Waterline separation distance ft. I D �/o /3
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
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box BU1U
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 — N
Engineer Report and As-Built Y— N
ETU Maintenance Contract Y N
provided
Location of System on Property:
Front R r Left Side Right Side Middle Front Middle Rear
S stem Use Sta s:
Approved
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 Inspecction Report 03 29 10.doc
Monci (0A c -- 1 -D
caloukic0 \
Septic Inspection Report
J-1-4--- -A-3)P Pe Po
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/ m , rt am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: v
NAME: ` > Pv•<\_66 PERMIT NO.: /k` 1 Ci/
LOCATION: g -P -t p_p_ INSPECT ON: /d —%S'-/.
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. C6- vc�-Q.t.. C;\---c.,
Depth of trenches ft.
Size of Stone -- G
Seepage Pits: Number U (. ` Al
Size: x
Stone Size:
Piping Size Type Vr2_45,v1 q....),C..7-
Building to tank
Tank to Distribution Box c/N)-�u
Distribution Box to Field/ Pit �%
Opening Sealed: Y N
End Cap Y N f r5
Inlet/Outlet Pipes& Baffles Y N �7
Manholes 12"or less below grade _Y N 1
[provide extension collar if Yes] _Y_ N
Location / Separations
Foundation to tank ft.
Foundation to absorption ¢• ft.
Separation of Pits
Conforms as per Plot Plan _Y ' N
Engineer Report and As-Built N
ETU Maintenance Contract _
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Statu .
Approved
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 Report 03 29 10.doc
i6ai•K
`7-72-L,,,_(,
Septic Inspection Re. ,rt
U.12Office No. (518) 761-8256 Date Ins on 1,, : e' ed: i'(L
Queensbury Building&Code Enforcement Arrive: l1.1 07717 , 'Depart: V• _► am •m
742 Bay Rd., Queensbury, NY 12804 Inspector's In*.-- :—r._
NAME: _ 1 i��i� I[) P NO.: ., l
LOCATION: ! ___ , l_ 1 'ECT ON: 1 10\ . l
RECHECK: = r 1, ti . ,_
Comments and/or diagram
Soil T : Sa Loam om/Clay
Type of Wate • Munici Well Water � pl,(;t _ ( 1'L-
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft. Fef`r1.-,..1 f (C
Well Casing Length 50' +/ - Y N N/A
[150'to well required if NO]
— 14'6 A-- —
Absorption Field: Total length t-1_ ft.
Length of each trench ;S@ 45 ft.
Depth of trenches In I-r e ft. --t- Van- ‘ c %sS.5T R uLap t\
Size of Stone •A: •2_ PER Ee �t�1i=
Seepage Pits: Number R a
Size: x
Stone Size:
Piping Size Type
Building to tank QC` A iA LEO `AG-7-
'tl G-7-\
Tank to Distribution Box
Distribution Box to Field/ Pit y" P•ec To \-t'" PE-0.F E i D5 L..o o\D D
Opening Sealed: Y/ N
E tO LooRE C) End Cap ,V`(T 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 y
Engineer Report and As-Built —Y 1•)E
-ED Maintenance Contract Y_ N ED E 1°`\EER_‘..5 RC-?ORT 5 M- BORT-
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
R
System Use s t '�� LQ Fo� DtJ1..`� (�,��,P �� DTb'�STEr\a
Approved
Partial Approved and nCreInsected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Bullding Codes Forms\Inspection Forms\Septic Inspection Report03 29 10.doc
� N
O O LU O
W 4
LL
LE-- � W�C p �a^ u9 1wLQ
'1{ppC C C 3' H Q2 Q VMS
rr^^ W
/ VJ W
W
g a2My^3U"off
Zmo®®®ao
Ln °j
v a
oo� a W
s
I o
_
K
IW \ NK¢ W�
I O�
JI_ —�Ye Ld I �n
\.. 4 K W
a v~ 2 W 7
J
cn
\ \ U
co W"o
CI
\ o W z
a
D—
W 'inWQ
� wtnZ�
4. cnw�o
maw¢
F.
Ei
91