2013-525 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130525 Date Issued: Monday, November 18, 2013
This is to certify that work requested to be done as shown by Permit Number P20130525
has been completed.
Tax Map Number: 523400-295-017-0001-022-000-0000
Location: 8 PINEWOOD HOLLOW Rd
Owner: GERALD & LEONA BEAUMONT
Applicant: GERALD & LEONA BEAUMONT
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
("TD jot
Issuance of this Certificate of Compliance DOES NOT relieve the
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: P20130525 Application Number: A20130525
Tax Map No: 523400-295-017-0001-022-000-0000
Permission is hereby granted to: GERALD &LEONA BEAUMONT
For property located at: 8 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: GERALD &LEONA BEAUMONT Septic Alteration Residential
8 PINEWOOD HOLLOW Rd
QUEENSBURY,NY 12804 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
2013-525
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,November 15,2014
(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 Tow of Qnsbul Friy November 15, 2013
SIGNED BYL./.--) v7-1/�vi ;<"-------
e" for the Town of Queensbury.
Director of Building&Code Enforcement
Community Development Office
Town of Queensbury - 742 Bay Road - Queensbury, New York -12804 NOV ! i ZU13
Office Use Only I C�
TAX MAP NO. c).9� ,I !"l'a ck PERMIT NO. 3'-5 C)• PERMIT FE '
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC !a'ISP®SAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK`nBEGINS.APPLICATIONOIS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
OWNER: �V I Y • f(f 0 r r INSTALR: 5 ,, /[ ,1� W O () ADDRESS: o vv r'r VVO((f,.,_-)- .
ADDRESS: U I � 4O1OL1M �
PHONE NOS. -1°)-e)) Lid-77 I PHONE NOS. 7r llV- (1�( OJ
)
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
NO.OF COMPUTATION = TOTAL DAILY FLOW
YEAR BUILT BEDROOMS X (Gallons per bedroom) GARBAGE GRINDNNER
1980 or older 7,1X 150 = 4 INSTALLED?
1981-1991 X — 130 = I SPA OR HOT TUN h
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT RO ING STEEP SLOPE h %SLOPE ^1 I
✓ SOIL NATURE: SAND LOAM N I CLAYN OTHER I V /1.
Ef '
✓ GROUNDWATER: AT WHAT DEPTH? N p, I
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WH DEPTH? lV iT
✓ DOMESTIC WATER SUPLY: MUNICIP WELL N f\(If well:water supply from any septic system absorption is: ft
✓ PERCOLATION TEST: RATE IS N PER MIINUTE PER INCH[moil (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: )CC 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: t
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length 2_0(t ft. Each trenc `1.1 x 5- U
V
❑SEEPAGE PIT(S)(WITH N0.3 STONE) How many? ‘-'11 Size?
❑ALTERNATIVE SYSTEM Bed or other type? \J .,t
❑HOLDING TANK SYSTEM Total required capacity? .. V Tank size? t1 Number of tanks?
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 th- re,ulations with respect to this application and agree to
abide by');e a c all r=•uirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sa r' ag• ', ;-al Ordinance. I )`{1codesCa aueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
Signatu/' of P• % in I`esponsibte Date www.oueensburv.net
C ( U -
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Septic Inspection Report
Office No. (518) 761-8256 Date In pection requ- -••
Queensbury Building&Code Enforcement Arrive: \VZD a em'''-part: = a. /pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials. _ _
NAME: S-(\V M \ • 'MIT NO.: – S
LOCATION: gS � �-, e. ci_,)UD I (((,Li 1 SPECT ON: V W/ 3
RECHECK:
04 Comments and/or diagram
Soil Type: ' Loam / Clay
Type of Water: unici•. ell Water _
Wate ' - �-paration distanceft.
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 i s ft.
Length of each trench 4-jQ 'Dft.
Depth of trenches ft. — s7 A\
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type _\ L-41
Building to tank 49 1
Tank to Distribution Box :-{ ' t Avg-1.4-, ,
Distribution Box to Field/ Pit /r-t "
Opening Sealed: 7 T - N
End Cap 4—N
Inlet/Outlet Pipes&Baffles ,VY
Manholes 12"or less below grade _N
[provide extension collar if Yes] •,_,_•,.N
Location/ Separations
Foundation to tank ft.
Foundation to absorption '2 ft.
Separation of Pi I. ft.
Conforms as per Pl. •Ian _ • N
Engineer Report and -B •
ETU Maintenance Contract _Y N
provided
Location of System on Property:
Front Rea Left Side Right Side Middle Front Middle Rear
S em s- S . •s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
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IN SUCH AS HOUSES, WELLS, REES, FENCES, ETC
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