2012-439 TOWN OF QUEENSBURY
742 Bay Road,Qucensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120439 Date Issued: Friday, September 14, 2012
This is to certify that work requested to be done as shown by Permit Number P20120439
has been completed.
Tax Map Number: 523400-309-013-0001-048-000-0000
Location: 8 CONNECTICUT Ave
Owner: JANE CAMPBELL
Applicant: JANE CAMPBELL
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 nforcement
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: P20120439 Application Number: A20120439
Tax Map No: 523400-309-013-0001-048-000-0000
Permission is hereby granted to: JANE CAMPBELL
For property located at: 8 CONNECTICUT 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. Tyke of Construction Value
Owner Address: JANE CAMPBELL Septic Alteration Residential
8 CONNECTICUT Ave Total value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
GEORGE DRELLOS 792-7257
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2012-439
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,September 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; Monday,September 10,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
_r-;:-.__--. Community Development Office
— Town of Queensbury • 742 Bay Road • Quet pur(y1\liaork •12804
Office Use Only a C I
TAX MAP NO.__3 O -(,[3-1._k/ PERMIT NO. / '7 PERMIT FEE#?-16) •v
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEMERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS PPLICATION IS SUBJECT TO REVIEW : • FORE ISSUANCE OF A ),LID PERMIT.
OWNER: j. 1`1 O !Z v__ INSTALLER7 1 LI � � _
ADDRESS: U Q C�T/ G V J ADDRESS: (IP0 9 �',Y` _y 6_F
PHONE NOS. )i— 7 9!„/ PHONE NOS._ 7 (Oa-Pc-5-'0
LOCATION OF INSTALLATION: P- C 0 N/LJ . 1/4I
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW T
BED ODMS (Gallons per bedroom) GARBAGE GRIND
1980 or older X 150 = INSTALLED?
1981-1991 X 130 = SPA OR HOT TUB I ,i
1992-present X 110 = INSTALLED? NJ LJ
PARCEL INFORMATION:
, /
i TOPOGRAPHY: FLAT ROLL 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 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: I 0 0 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?
ALTERNATIVE SYSTEM ed 'other type? 1 0 'X30
❑ HOLDING TANK SYSTE otal required capacity? ____Tank size? _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.
av read the -•. .tions with respect to this application and agree to
i by thes ..al requi •ents of the Town o Qu ensbury QUESTIONS? CALL 761-8256 OR EMAIL
itary Se I, D .-.0 �, &lance. codes(a�queensbury.net
ig ature of son Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
C (0 S-C-- ) 2 ,2
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Septic Inspection Repo
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OfficeNo. (518) 761-8256 Date Ins ion r-' ' e�!iv y•: ,
Queensbury Building &Code Enforcement Arrive: L,, \V - ' ' •rt: a •m
742 Bay Rd., Queensbury, NY 12804 Inspector's Initia 7.0110
NAME: C44r"‘ l �/ Pre MIT NO.:
LOCATION: 55 (-cam AC.C_1-- c-iii i I of , ,',SPECT ON: MEN
RECHECK:
Comments and/or diagram
Soil Type. a'_ •*. ' ay
Type of Water: ' • cipal 'ell Water
Wate - - •aration distance \r----) _ 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
i ,k Size: x V
Stone Size:
Piping Size Type
Building to tank L.1,
i/L,k *t
Tank to Distribution Box /W,' /.,L3`' ` I ^
Distribution Box to Field / Pit c2-rj, v��(
Opening Sealed: N
End Cap _ N
Inlet/Outlet Pipes&Baffles N
Manholes 12"or less below grade _ N
[provide extension collar if Yes] _Y_ N
Location/ Separations
Foundation to tank Oa . AS BUILT
Foundation to absorption
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 Rear Left Side Right Side Middle Fro Middle Rear
S stem Use S tus:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
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CENTER PROJECT
SERVICES
73 Sheridan Street, Glens Falls, NY 12801
Phone-518-796-2515
August 22, 2012
Project# 163
Dan Drellos
Sanitary Sewer Services
Luzerne Road
Queensbury,NY 12804
Re: Proposed Replacement Septic
Campbell Residence—8 Connecticut Ave, Queensbury, NY
Dear Dan:
At your request we have reviewed your proposed replacement septic system design at the site of
the existing 2 bedroom house of at 8 Connecticut Avenue in Queensbury. As per our
conversation the residence has an existing failing septic system.
We have reviewed the proposed replacement septic system design and we agree that a standard
absorption bed is acceptable. Based upon a design flow rate of 220 GPD and a percolation rate of
1 to 5 minutes, you will need 232 square feet of absorptive area. We recommend using a 10 ft
wide by 30 ft long absorption bed with 3 — 25 foot long laterals, which will provide 300 sf of
absorptive area. The absorption bed will be constructed with a new 1,000 gallon septic tank, new
distribution box, and 4 inch diameter perforated pipe and stone.
Please feel free to contact me at 796-2515 if you have any questions and that you for your
assistance with this request.
Sincerely,
Thomas R. Center Jr, P.E.
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
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