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2004-430
TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20040430 Date Issued: Wednesday, September 28, 2005 This is to certify that work requested to be done as shown by Permit Number P20040430 has been completed. Tax Map Number: 523400-301-017-0003-035-000-0000 Location: SHERMAN Ave 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 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 nforc ent Planning Board or Zoning Board of Appeals. T TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040430 Application Number: A20040430 Tax Map No: 523400-3 01-017-0003-03 5-000-0000 Permission is hereby granted to: SHF,RMAN PINF,S HOMF,OWNF,RS ASSOC;. For property located at: SHERMAN 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: SHERMAN PINES HOMEOWNERS Septic Alteration Residential %DE ROO ASSOC., INC. PO BOX 2105 Total value BALLSTON SPA,NY 12020-8105 Contractor or Builder's Name /Address Electrical Inspection Agency MORNING STAR SEPTIC Plans&Specifications 2004-430 SEPTIC ALTERATION l $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, June 15, 2005 (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 of eens s y, June 15, 2004 11 SIGNED BY for the Town of Queensbury. Director of Building&Code ' forcement . Application for Permit Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: nn Office Use Location of installation: J t � c File Permit No. Tax Map No. Fee Paid Owner's Name: �o r.,,�.ra.. - I ............................................................................................................................... Address: I 'oa-�L� 5 ae- y.Sr/. 17-0 2y -�'i o� -- r`"'� C. 2. INSTALLER'S NAME : /bi z..• S fog S c L PHONE NO. `75 33 22 90 - 9 c�V�5)13 q 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply#of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x Computation = Total Daily Flow . R 1980 or older x 150 gal/bdrm = JUN $ Z004 1980-1991 x 130 gal/bdrm = 1991-present x 110 gal/bdrm = TOWN OF ()UEEN��E gU1LD1NG AND Garbage Grinder Installed yes_ / no n_ Spa or Hot Tub Installed yes_ ./ no '!v -5`l 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Suntly . sad at what depth at what depth munid Rolling loam feet feet well Steep slope clay if well; water supply slope other from any septic-system depth: absorption is ft. other Percolation Test: (To be completed by Zicensed professional engineer or architect) Rate: minute per inch 5. 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). Add 250 gallons to the size of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub. Septic Tank: gallon(min.size 1,000 gal) Tile Field: each trench ft. Total System Length: fl. Seepage Pit(s): number of size of each: ft, by ft. Size cif Stone to be used: # / depth or thickness 1 q feet Bed/System Size: 2 5-' x 5' Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency. 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read) 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 these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. Signature of r6sponsible person Date 1 , 'a • , r ;'1'ow'tl of (Zttu-ctttshu'ry ,S�;wtaw and No"ovtige. IA.4vamal Cho pler Ainvo-mll x C, ' All.-S )Ii,P'PI(2N' l;'llP;l-ol.) SPHI 11t11TIO N ItIP-Q JA I11,N 114. S � � }PQ,vN 1 ? Q 1'feu. tH �IhTf f{• as Ulm . /,/ •r•�.u••war r'�.+q/!. cli r „ f '� '� ' S�t't lc♦ v,' w . t�Y�Lt'tK1 t frlRL:b � . ' • ww r ' ?. SIONXTURE &INFORMATION FOr,UMl6N' ;SwLr,,rzgvz%,,vi wwo • `� 169 Haviland Road Quwnsbury,NY 12804 Hutchins En ineerin Phone:(518)745-0307 9 9 Fax: (518)745-0308 June 11, 2004 Mr. Frank Shaw VIA FAX-793-2115 Morningstar Septic Service 1 Page 107 Jewell Road Gansevoort, NY 12831 Reference: 52 Autumn Ln, Queensbury (T), Sherman Pines Subdivision Septic System Replacement Dear Frank: On this date this office completed a soil percolation test in soils that had been amended for a replacement bed system at the referenced residence. The bed area has been excavated and soils newly amended to two feet below bottom of bed stone layer due to reported fast percolation rate of native soils. The absorption bed is being replaced in accordance with the original subdivision engineering plans prepared by Morse Engineering in 1992. _ The stabilized percolation rate in the amended material was 2 minutes 30 seconds. Please contact me if you require additional assistance. Best Regards, G. Thomas Hutchins, P.E. Cc Dave Hatin, Town of Queensbury G.Thomas Hutchins,P.E. Septic Inspection Report Office No. (518)761-8256 Date Inspection r ues i Queensbury Building&.Code Enforcement Arrive: am/ irt: _am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initi s: NAME: �P � 1 N3 F P IT NO.: LOCATION: ��, Z,jlj to �r,(4fllHI}I�tll LA13F ECT ON: Q —Z 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. 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 Distribution Box to Field/Pit Opening Sealed: Y/N/Partial End Caps Location/Separations Foundation to tank ft. Foundation to absorption Separation of Pits ft. Conforms as per Plot plan—_-, N Engineer Report Chd As-Built LY N Location of System on Property: Front Rear Left Side Right Side 4St t Middle Rear System pproved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved Last revised 1/6/05 L- Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/p I?,epart: 4 'g4A am/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: NAME: Ct1`�mh =�-ke� PERMIT NO.: LOCATION: '�'i '"C INSPECT ON: f D RECHECK: Comments and/or diagram Soil Type:Q.,SawKLoam/Clay Type of Water unici /Well Water Waterline separa on distance Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. 6vOS Length of each trench ft. Depth of trenches ft. Size of Stone -Zi Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution ox '' S 3r Distribution Box,& ield/Pit Opening Sealed: Y N/Partial Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y �jvAj l 5 Location of Sy on Property: Front Rear Left Side Right Side Middle r nt Middle Rear System Use Status: pproved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved LASueHemingway\13uilding.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 FROM] FAX NO. Sep. 27 2004 08:18RM P2 MORNING STAR EXCAVATING, INC.. & SEPTIC SERVICE 107 Jewel Road 518-793-2290 Frank Shaw, Pres.. Gansevoort, NY.12831-2154 518-695-5505 . Fax#518-793-2115 Date: TO: lei°- 12648 I V�L OI_CE: Terms: Payment Due Upon Receipt of Invoice 1 1/2% Interest After 30 Days Ta 0 4-ir i 3 T, 17-9vy'- 7IOQ I y /o� . I ES �0 �V�� �jb�� G � tie4 4r� p�Q! YiDMti J . io L1.3 P/b- 1-7 l6 G Z/" r S7"fit t' Town of Cu Building & Code Enforcement Office No. (51$) 761 8256 Septic Inspection Report Inspection request received: Name: S��n� � 6—^c�� Inspected on: -� 117 ) Location: i o p Arrive: d /P.M. Permit No.: ., .4 G7 Inspector's Initials: 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'V Y N/A [150'to well required if NO Absorption Field: Total le gth Ift. Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping I ASize Type Building to tank Tank to Distribution B x Distribution Box to Fi Id/Pit Opening Sealed: _Y_N End Cap _Y_N Inlet/Outlet Pipes&Bb es 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_N Engineer Report and As-Built _Y_N ETU Maintenance Contract provided _Y_N LocationZRear : Sid Right Side Middle Front Middle Rear S stem oved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report UO;C: mw wp saw .w a rA z ac •.a a cn 'v y 1 - A o M ►i`� ` �' N N Fy O W A co H V'. W T 99 1_Sy,� z ,�d d! t '� �r�J``I w iOA O M WNW 6a :. Q N ; ILDING KEPT o �► � �a w �,� F�ra M r+o�• mQ t f� Zrq ,,A ��M u•1OO A 00 f oo e � M: � .,toNVIEWEDB`' .t c� SE: ,,,0 WA TE f N 0 C4 to ,t i Uto Hn� i en to enpAq> a Inh+ Oc�o y CO z An Co at (� f a 8� AW OApvl .A`s., ., r a W y.�,p4CA��� a' � � aa��w�� xra C] X ,, •�,,,,,� ,. � ��-�'� p -47 CIO uG G - v A ' Y R?Y i .. _ r = I- ,art *•#+�-xa �. r �,, _ - ' 3 `' ` z rt ti Ak I r i r" e *,.--.--,_ „ : - _ ,•µme � � rt � �,� � , 60 0 F ry. Na Cn v N J ' r, - x -:o w Z •Q`Q^' «',Z r+l .. 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