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TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130207 Application Number: A20130207
Tax Map No: 523400-295-017-0001-039-000-0000
Permission is hereby granted to: DON&PENELOPE PITT
For property located at: 23 PINEWOOD HOLLOW 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: DON&PENELOPE PITT
Septic Alteration Residential
23 PINEWOOD HOLLOW Rd
QUEENSBURY,NY 12804-0000 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
IBS SEPTIC &DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY.NY 12804
Plans&Specifications
2013-207
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,May 17,2014
(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 o6 e
Que urid 2013
xf
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Community Development Office
.`+ Town of Queensbury - 742 Bay Road - Queensbury,[M`kv Va�k2� 04
Office Use Only
3
TAX MAP NO. �� : � PERMIT NO. 3 ��� PERMIT FEE
APPROVALS: ZONING TOWN CLERK 0a
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE'RK BE INS APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
OWNER: `J n INSTALLER: s
ADDRESS: ADDRESS:
PHONE NOS. I 1 5 ` p PHONE NOS.
v�/
LOCATION OF INSTALLATION: j� t� Doe Woyi
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT BEDROOMS X Gallons per bedroom - TOTAL DAILY FLOW GARBAGE GRIN�F�
1980 or older X 150 = INSTALLED?
1981-1991 X 130 = 0 SPA OR HOT Tl
1992-present X f 110 = INSTALLED?
PARCEL INFORMATION: i
✓ TOPOGRAPHY: FLATVLG STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND OAME CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? W
✓ BEDROCIVIMPERVIOUS MATERIAL: AT WH DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL € If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH(mpij (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: �9 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 PE: � (
ABSORPTION FIELD(WITH NO.2 STONE) Total length 1_n—ft. Each trench `T X
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? N _ Size?
❑ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity? .Tank size? Number of tanks?
V1
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 have read the regulations with respect to this application and agree to
abide by hese and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
S nitary ew ?I isposal Ordinance. I--�, r codes(cDaueensburv.net
Sign ure o rs Responsible Date�) VISIT OUR WEBSITE FOR MORE INFORMATION
www.gueensbury.net
NYS-Real Property System Subject Property Inventory Summary RPS030N04/1_001
County of Warren For Current Year File 2013 Date:5/17/2013
Town of Queensbury Parcel ID:295.17-1-39 Sheet 1 of 1
SWIS Code-523400 Active
Parcel Information Parcel Land Size File Maintenance Info
Curr Owner: Pitt,Don L Acct#: Front: 0.00 Acres: 0.48 Created: 11/20/1984
Location: 23 Pinewood Hollow Rd School Cd: 523402 Queensbury Un.fr.: Depth: 0.00 Sq Ft: 0 Modified: 05/01/2013 03:02 PM
Queensbury,NY 12804 Roll Sect: 1 Taxable RS/S: Grid Coordinates By: Batch FM by teri
Prop Class: 210 1 Family Res East: 698484 North: 1640825 Folder: ASSESSMENT
Site Characteristics
Site No: 1 Nbad Cd: 162 OldSubdv,Rs,RL Site Desire: 2 Typical DC Entry Type: 1 Inter inspec Economic Obs: 0
Site Type: R Residential Sewer Type: 2 Private Nbad Type: 2 Suburban Zoning Cd: MDR Mod Density Re Data Mailer: No
Prop Class: 210 1 Family Res Water Supply: 3 Comm/public Nbad Rating: 2 Average Last Phy Insp: 05/01/2013
Route No: Utilities: 3 Electric Road Type: 3 Improved Reappraisal: 08/26/2004
Residential Building Information
Bldg Style: 05 Colonial No.Bath: 1 Fuel Type: 3 Electric Grade Adjust: 0 Area in Sq.Ft.
No.Stories: 2.0 No.Half: 1 Central Air: No Pct Good: 0 1st Story: 992 Fin Bsmnt: 0
Ext Wail Mtri: 03 Alum/vinyl Bath Qual: 3 Normal Bsmt Type: 4 Full Func Obs: 0 2nd Story: 728 Unfin 1/2: 0
Act Yr Bit: 1984 No.Bdrms: 3 Bsmt Gar Cap: 0
Add[Story: 0 Unfin 3/4: 0
Eff Yr Bit: No.Rooms: 7 Overall Cond: 3 Normal
1/2 Story: 0 Unfin Rm: 0
Yr Remodel: No.Fireplcs: 1 Ext Cond: 3 Normal 3/4 Story: 0 Unfin Ovr Gar: 0
No.Kitchen: 1 Fireplc Type: Int Cond: 3 Normal Over Garage: 0 SFLA: 1,720
Kitchen Qual: 3 Normal Heat Type: 4 Electric Constr Grade: C Average Fin Attic: 0 Fin Rec Rm: 221
Land Breakdowns
Land Soil Wtrfrt Depth Infl Infl Infl Infl Land Unit Dim
Type Front Depth Acres Sq Ft Rating Type Factor Pct Cd 1 Cd 2 Cd 3 Value Price Code
01 Primary 0.00 0.00 0.00 20,909 0 0 32300 67290.265
Additional Improvements
Structure Measure SQFT Overall Act Eff Yr Pct Func Sry Unit Bid Bid
Code Code Diml Dim2 MISC Qty Grd Cond Yr Built Gd Obs Life RCN RCNLD No. No. Sec
RG1 Garage, 1 StoryAttached Dimension 20.00 22.00 .00 1.00 C Norm 1984 0 0 0 10872 9676 0 0
RP3 Porch,Screened Dimension 10.00 12.00 .00 1.00 C Norm 1984 0 0 0 3692 3286 0 0
RP2 Porch,Covered Dimension 6.00 9.00 .00 1.00 C Norm 1984 0 0 0 1788 1591 0 0
RP1 Porch,Open Dimension 14.00 20.00 .00 1.00 C Norm 1991 0 0 0 3153 2964 0 0
M
P
Septic Inspection Re rt
Office No. (518) 761-8256 Date Inspection
Queensbury Building &Code Enforcement Arrive: 1 /p D rt: �3 m/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initia
r
NAME: � PE IT N
LOCATION: 3 `scP.t� �� IN PECT ON:
RECHECK:
Comments and/or diagram
Soil T m Clay
Type of Water Munici Water
Waterline se ration distance i=ce — 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 QQ ft.
Length of each trench ft.
Depth of trenches – ft.
Size of Stone -tr-
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank H \A0
Tank to Distribution Box
Distribution Box to Field Pit Tb tl'\
Opening Sealed: _ N
End Ca _ N
Inlet/Outlet Pipes&Baffles 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 P' ft.
Conforms as r lan _ N
Engineer Re nd As-Buil _Y N
ETU Maintena Y_N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Stat :
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\13ullding Codes Forms\Inspection Forms\Septic Inspection Report 03 2910.doc
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SEPTIC PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS,TREES, FENCES, ETC
K.WN ON THIS DOCUMENT,I HAVE PERSONALLY
M ASI DISTANCE SET FORTH ON THIS DIAGRAM.
SIG AT DATE
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