2013-456 TOWN OF QUEENSBURY
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742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130456 Date Issued: Friday, October 04, 2013
This is to certify that work requested to be done as shown by Permit Number P20130456
has been completed.
Tax Map Number: 523400-288-008-0001-026-000-0000
Location: 79 STATE ROUTE 149
Owner: MARY ANNE HILDER
Applicant: MARY ANNE HILDER
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 /1
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.
0.14 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130456 Application Number: A20130456
Tax Map No: 523400-288-008-0001-026-000-0000
Permission is hereby granted to: MARY ANNE HILDER
For property located at: 79 STATE ROUTE 149
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: MARY ANNE HILDER
Septic Alteration Residential
79 STATE RT. 149
LAKE GEORGE,NY 12845 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2013-456
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, September 27, 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 Que sbul Fr'i :y p e i tember 27,2013
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Community Development Office SEP1 13
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 fit,
Office Use Only
TAX MAP NO. &X $ g • -I�a(� PERMIT NO._ I ✓ �`
P 6-69 PERMIT FEE (�z�
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: AZ I-3 Avis' /7,l e/ ,lJ INSTALLER: �/4"1"/ //t,4f ,(C4-�Y/�
ADDRESS: 79 AVS. /2/—. f/9 62. 7 ADDRESS: /* . /Jp'e 22 % Cr7Pl7 /://r /1-Ar. /?iv)
PHONE NOS. / PHONE NOS. S 1 - 79„2-7?f
LOCATION OF INSTALLATION: &CLk ytrJ
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = INSTALLED? /"v
1981-1991 X 130 = SPA OR HOT TUB
1992-present 3 X 110 = 33o INSTALLED? NU
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING)< STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND 6.C. 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: �GZ7/ 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:
0 ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X
0 SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
Lg_ALTERNATIVE SYSTEM Bed or other type? ;�2 O �,;r Z o
0 HOLDING TANK SYSTEM Total 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.
I have read the regulations with respect to this application and agree to
abide by these and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
San' : Sewa a Dis O •• nce. f 7 I codese.queensbury.net
VISIT OUR WEBSITE FOR MORE INFORMATION
Signat - of Person Responsible Date www.queensbury.net
Septic Inspection Repo
Office No. (518) 761-8256 Date Inspection requ• • eiv• •:
Queensbury Building &Code Enforcement Arrive: 7%00 a Cla :epart: Z`�a_17
ar mj
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: \A\ �[� �� •ER NO.: I 1/4:7) - - to
LOCATION: 7) hTIATF IN 'EU ON: IES -3 —l3
RECHECK:
Comments and/or diagram
Soil Type: Sand / Loam/ Clay
Type of Water: Municipal/ Well Water
Waterline separation distance _ ft.
Well separation distance ft. 0O.-V- n �A p \\
Other wells: ft. C1
Well Casing Length 50' + / - Y N N/A `1
[150'to well required if NO] R� �-��\� Z-�yV �M 0
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
End Cap _Y_ N
Inlet/Outlet Pipes&Baffles Y N
Manholes 12"or less below grade _Y_ N
[provide extension collar if Yes] TY— N
Location/ Separations
Foundation to tank ft.
Foundation to absorption _ ft.
Separation of Pits ft.
Conforms as per Plot Plan _Y N ` l- ' 1[� ' n ` k) -7
G 1 `�
Engineer Report and As-Built •,�Y_ N
J�
ETU Maintenance Contract _Y_ N OK o Pit ` m R`i L1 g
provided
Location of System on Property: ' ` 00
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 Farms\Inspection Forms\Septic Inspection Report 03 29 10.doc
Septic Inspection Report
Office No. (518) 761-8256 Date Inspectio equ ..3- v-•.
Queensbury Building &Code Enforcement Arrive: Z--4,a ' P.rt: =1%5 a pmt
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: L\ P' • NO.: 13
LOCATION: JITP VAR I .'ECT ON: _ID --___Lja:LIZ
RECHECK:
Comments and/or diagram
Soil Type: San jinciffaja
Type of Water: Municipal/ Well W t
Waterline separation distance n 1A ft.
Well separation distance \no ft.
Other wells: 1 M-)
ft.fi
Well Casing Length 50' +/ - Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft.
Length of each trench 4 .
Depth of trenches 2__._... ft.
Size of Stone "7.—
Af�c Q rTh►, g 4 Size: 2.O x O
Stone Size:
Piping Size Type
Building to tank LA + A
Tank to Distribution Box 4 ` fj n � _
Distribution Box to Field/ Pit /� ` ' �j D ��� �v '\' bO
Opening Sealed: Y Y N
End Cap - 7• F� Pc�� —
Inlet/Outlet Pipes &Baffles V Y /�
Manholes 12"or less below grade � V N
[provide extension collar if Yes] ' T _ N
Location/ Separations
Foundation to tank (O ft.
Foundation to absorption .cr) ft.
Separation of Pits ft.
Conforms as per Plot Plan Y_ N
Engineer Report and As-Built _Y_ N
ETU Maintenance Contract Y_ N
provided
Location of Syste on Property:
Front / Rea Left Side Right Sid Middle Front Middle Rear
stem Use S :tus:
• 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
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CENTER PROJECT /L�
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SERVICES
73 Sheridan Street, Glens Falls,NY 12801
Phone- 518-796-2515
September 22, 2013
Project# 176
George Drellos
Sanitary Sewer Services •, ;• N 3
Luzeme Road SE►
Queensbury, NY 12804
Re: Proposed Replacement Septic
Hilder Residence—79 NYS Route 149, Queensbury, NY
Dear George:
At your request we have reviewed your proposed replacement septic system design at the site of
the existing 3 bedroom house of at 79 NYS RT 149 in Queensbury. As per our conversation the
residence has an existing failed 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 330 GPD and a percolation rate of
1 to 5 minutes, you will need 347 square feet of absorptive area. We recommend using a 20 ft
wide by 20 ft long absorption bed with 4 — 15 foot long laterals, which will provide 400 sf of
absorptive area. The absorption bed can 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.