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2013-456 TOWN OF QUEENSBURY fr 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 well ►s SPr,N }'e cQ rvo we_ ! ,'r o_, ii2 4r ANN 14/he r . f13y' It /9 F �, PPNs,&��-v, l'y 2 S ±' 2013 \P ��i,. . ./ if� TOWN OF 00E'; • BUILDING ,.: . : 4 )i Reviewed , ,] 1 Date: --- -- 1 '� ---- t'1 0 X r i : _____\\\\.\ i @� 8 v tC 01 0 lo sE LOT PLAN I HAVE SEEN R OBSERVED ALL OBJECTS SUCH AS HOUSE ,WELLS, TREES, FENCES, ETC Vtil SHOVIN 1}OCUMFNT1HAVEPERSONALLY MEA" HE p;�SET FO THIS DIAGRAM. g--\--- _ 1 1 ,;IGr�:� RE DATE CENTER PROJECT /L� �-, 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.